BUNDLED INCLUSIVE – MODIFER 59 USED

BUNDLED INCLUSIVE – MODIFER 59 USED

               

Above scenario, procedure code 93458 was denied by insurance stating bundled however 59 modifier was used. Please see two scenarios which you might encounter –

CLAIM STILL NOT REPROCESSED BY PAYER

Received denial from --------- for procedure code ------- stating bundled/inclusive. Found procedure code ------ was billed with modifier 59 which states “Distinct procedural service and they should reimburse separately”. Insurance should have reimbursed this procedure code separately. Cld -------  @ ----------  to verify if procedure code was reviewed with modifier 59 and still denied as inclusive, spoke with ------- said procedure code ------- was denied though it was billed with 59 modifier as bundled/inclusive and suggested we rebill claim with more appropriate modifier or appeal the claim with supporting documents.

Please review coding for procedure code -------- - 59 and see if any changes can be made and rebilled. If not, please advice if we need to appeal.

CLAIM SENT FOR REVIEW / REPROCESSING -

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Received denial from --------- for procedure code ------- stating bundled/inclusive. Found procedure code ------ was billed with modifier 59 which states “Distinct procedural service and they should reimburse separately”. Insurance should have reimbursed this procedure code separately. Cld -------  @ ----------  to verify if procedure code was reviewed with modifier 59 and still denied as inclusive, spoke with ------- told rep we should have been reimbursed separately. Rep said claim is being sent for review again since we have used 59 modifiers and suggested we allow ------- days for reprocessing. Reference # -----------.

BUNDLED / INCLUSIVE – MODIFIER LIST ATTACHED AT THE BOTTOM – BELOW WOULD BE SAME FOR COMMERCIALS TOO

MEDICARE DENIAL – NO MODIFIER USED

Received denial from ------- for procedure code ------- was denied stating CO97 - Bundled/Inclusive. Remarks - N20 Service not payable with other service rendered on the same date. Primary procedure code --------- was billed on same day and was paid by ins and denied procedure code does not have a modifier.

Please review coding for procedure code ------- and see if claim can be rebilled with appropriate changes. If it was billed appropriately, please wt do with balance?

EXCEPTION –

PROCEDURE CODE 36416 & 94760 CAN BE ADJUSTED US IF DENIED. NO NEED TO RAISE THIS TASK

RAISE – CLT 5 : CODING / BILLING TASK

MEDICARE DENIAL – MODIFIER USED

Received denial from ------- for procedure code ------- was denied stating CO97 - Bundled/Inclusive. Remarks - N20 Service not payable with other service rendered on the same date. Primary procedure code --------- was billed on same day and was paid by Medicare and denied procedure code was billed with modifier -----. Cld Medicare @ ------------, spoke with -------- told her denied procedure code was billed with modifier and inquired if Medicare still denied as inclusive. Rep said procedure code ------ was denied as inclusive though billed  modifier ---- and suggested we either rebill with appropriate coding changes or appeal the claim with supporting documents.

Please review coding for procedure code ------- and see if claim can be rebilled with any other appropriate changes. If it was billed appropriately, please advice if we need authorize adjustment.

EXCEPTION –

PROCEDURE CODE 36416 & 94760 CAN BE ADJUSTED US IF DENIED. NO NEED TO RAISE THIS TASK

RAISE – CLT 5 : CODING / BILLING TASK