Payer Spotlight:
96110 Modifier Requirements Change Again
Published on Fri Aug 27, 2010
BC/BS UHC, tell coder to halt 96110-59 denials with 96110-79.If you're ready to bill 96110 and 96110-59, think again. One pediatric office was billing 96110 (Developmental testing Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) with modifier 59 (Distinct procedural service). BlueCross/BlueShield (BC/BS), UnitedHealthcare (UHC), and other insurers were denying the 96110-59s. "I called BC/BS on 8-19-2010 and was told that we should be using a 76 (Repeat procedure or service by the same physician) modifier instead," reports Bonnie Palmer, with Lawrenceville Pediatrics in Georgia. "I also called UHC and was told the same thing." 96110 x 2 or 96110-59 Is Technically Correct Modifier 59 rather than 76 more appropriately describes two distinct 96110s. When you're reporting two 96110s, you're doing so to represent two different tests, not a repeat second test as modifier 76 represents. That being said, the American Academy [...]
