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BS Denial 77003

  1. #1
    Location
    San Diego Chapter
    Posts
    18
    Question BS Denial 77003
    Medical Coding Books
    We are getting denial froms Blue Shield indicating that 77003 is not payable with injection code 62310 stating that is considered inclusive. Is anyone else having this same problem?

  2. #2
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Who are you billing for...facility, anesthesiologist, surgeon? Are you putting the appropriate modifier -26 or TC on the 77003?

  3. #3
    Location
    San Diego Chapter
    Posts
    18
    Default
    for pain doctor and yes we are attaching the modifier 26

  4. Default
    I work for pain practice and we use 77003 with the 26 modifier and never get denied for inclusive I would send investigation thru Navanet.

  5. #5
    Location
    St George, UT
    Posts
    37
    Default
    We are having this same problem with Regence BCBS in Utah. They state they use CPT, CCI and various other common guidelines to determine coverage (all of which allow the payment of fluoro). But then they go on to deny based on their own "supplemental" correct coding edits to deny the 77002 and 77003 when billed with some injection codes. Our appeals have been unsuccessful. These guidelines can be found online under their medical policy section.

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