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Thread: Humana

  1. #1
    Join Date
    Apr 2007
    Location
    Charleston, WV
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    73

    Default Humana

    We recently received a refund request from Humana asking for money back from 2012. Seems like they are applying a multiple reduction when we billed a LHC & a stent. It appears like they are adding a 51 modifier to the heart cath. Does anyone know if we should be appending it? I want to keep from having any more requests from them.


    Jessica Chandler CPC, CPC-H, CPC-P, CCC
    Charleston, WV[/COLOR]

  2. #2
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    Apr 2007
    Location
    Green Bay
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    Default

    Quote Originally Posted by jessica1974 View Post
    We recently received a refund request from Humana asking for money back from 2012. Seems like they are applying a multiple reduction when we billed a LHC & a stent. It appears like they are adding a 51 modifier to the heart cath. Does anyone know if we should be appending it? I want to keep from having any more requests from them.
    According to the Medicare Physician Fee Schedule the multiple surgery indicator for the cardiac cath codes is "2" which means that, yes, multiple surgery reduction would apply.

    Jessica CPC, CCC

  3. #3
    Join Date
    Apr 2007
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    Ann Arbor
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    Default

    Quote Originally Posted by jessica1974 View Post
    We recently received a refund request from Humana asking for money back from 2012. Seems like they are applying a multiple reduction when we billed a LHC & a stent. It appears like they are adding a 51 modifier to the heart cath. Does anyone know if we should be appending it? I want to keep from having any more requests from them.
    Try modifier-59 with the heart cath code, as long as the LHC was diagnostic and not guiding shots.

    Thanks,
    Jim Pawloski, CIRCC

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