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Does modifier apply?

  1. #1
    Default Does modifier apply?
    Medical Coding Books
    Good afternoon fellow Coders,

    I recieved a denial from Medicare for the following listed below.


    88305
    88305-76
    88313
    88313-59

    Medicare is saying that the 1st 88313 needs a modifier and that this code can be quantity billed any thoughts on this claim.

    Thank you,
    TH

  2. #2
    Default
    Quote Originally Posted by tholcomb View Post
    Good afternoon fellow Coders,

    I recieved a denial from Medicare for the following listed below.


    88305
    88305-76
    88313
    88313-59

    Medicare is saying that the 1st 88313 needs a modifier and that this code can be quantity billed any thoughts on this claim.

    Thank you,
    TH
    I think by 'quantity billed', they mean you can bill it as a single line item with multiple units, but I could be wrong about that. I'm not sure what modifier they're wanting on it, unless you billed other services that day, since 88313 doesn't bundle to 88305 in the NCCI edit tables. It sounds like they want you to submit the claim as 88313-59 with 2 units, to me. Your best bet will be to call them and get clarification. Find out what they mean by "quantity billed", and why they're saying that 88313 needs a modifier. Don't ask which modifier you need - they won't tell you that. They can tell you why it needs a modifier, though, which is a round-about way of getting them to tell you which one they want. If they don't explain it in a way that makes sense, keep asking questions until you understand it perfectly. Don't worry about sounding dumb - in fact, I encourage you to sound as clueless as possible. You usually get further that way. Good luck!

  3. #3
    Default
    Thank you Brandi I will give them a call.

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