# Humana denial



## tmarugg (Feb 17, 2016)

Our patient underwent carpal tunnel surgery.  Humana has denied the claim stating a modifier is required for this procedure.  The other coder in our office & myself were discussing the fact that since ICD-10 has expanded diagnosis codes (like this one) to included specific location, is a modifier still required?  Our ICD-10 code indicates right wrist.  

This issue has never occurred to us.

Thanks in advance for your thoughts on this.


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## CodingKing (Feb 17, 2016)

ICD-10 is separate from CPT. Rules regarding CPT and modifiers have not changed.


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## mhstrauss (Feb 17, 2016)

tmarugg said:


> Our patient underwent carpal tunnel surgery.  Humana has denied the claim stating a modifier is required for this procedure.  The other coder in our office & myself were discussing the fact that since ICD-10 has expanded diagnosis codes (like this one) to included specific location, is a modifier still required?  Our ICD-10 code indicates right wrist.
> 
> This issue has never occurred to us.
> 
> Thanks in advance for your thoughts on this.




No changes were made for laterality modifier usage for CPT. You'll still need to use LT/RT for the codes that have required it in the past. And actually, Humana seems to be getting stricter with this requirement in the year, it seems.


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## hopepg (Feb 18, 2016)

If it's Humana, they'll still want anatomical modifiers. 
I agree modifiers should still be added where appropriate no matter the changes with ICD10. In my experience, Humana always seems to be (for lack of a better word) more strict compared to other payers. If the anatomical modifier is missing for a patient with another payer, that claim might still be reimbursed/allowed. The same claim/coding for a patient with Humana often won't get past their claim edits.


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