Practice Management Alert

Question: Some of my payers dont recognize HCFAs modifiers, such as -59, so I usually get denials and always have to appeal. What should I do to get reimbursed?

California Subscriber
 
Answer: Unfortunately, if the payers computer edits are causing the erroneous denials, it is a typical frustration of our industry. If communication back to the payer regarding the incorrect denials does not prove effective, and the practice wants to continue accepting assignment, you will have to continue to work the denials. More often than not modifier -59 (distinct procedural service) is not coded appropriately due to misinterpretation of the CPT code to which it is appended or guidelines such as unbundling. Submitting the physicians notes with the claim or sending the notes for review at the time of denial will help facilitate appropriate payment.

 -- You Be the Expert and Reader Questions answered by Lorraine Goupee, CPC, NRCMA, compliance officer for quality assurance at Lighthouse Orthopedic Associates in Lighthouse Point, Fla.; Stephanie L. Jones, NRCMA, NRCAHA, CPC, director of audit programs at eCompliance Doc in Miami; and Catherine A. Brink, CMM, CPC, president of Healthcare Resource Management Inc. in Spring Lake, N.J.