Wiki 20610 multiple joint denial

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urbach34@yahoo.com

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We have been getting denials from Anthem when billing 20610 on multiple joints at one visit. We have several different scenarios...bilateral knees with Rt shoulder, bilateral shoulder with Rt hip, etc. We have billed them as 20610-50 (linked to the bilateral joint dx codes) and 20610-XS-Rt (linked to Rt dx code). They have come back denying the single 20610, but paying the bilateral. When our follow-up girl has spoken to an Anthem rep, she was told that they won't pay the 20610-XS-Rt, because they already paid for a 20610-Rt in the 20610-50.
We then tried rebilling as corrected claim as 20610-Rt 2 units (linked to the 2 different Rt dx) and 20610-Lt (linked to the Lt dx). They have still come back denied.
Our follow-up girl is asking if we can simply bill 20610 3 units linked to all dx, with no anatomical modifier. She said they keep telling her they want it on one line. I'm so confused. Has anyone else run into this problem? How do you suggest we bill these? Is there a problem with using XS modifier with Anthem??

Please help!
 
Have you tried using a modifier 59 - Distinct procedural service

For example code the bilateral knees with the 50 modifier and then when you go to code the shoulder put a modifier 59 on that one.

20610 - 50
20610 - RT - 59

Maybe that would work.

LLR
 
XS vs 59

I have found that some payers do not accept the X modifiers that replaced modifier 59 yet. I would try with 59 as LLR suggested above.
 
Thanks for the feedback

Thank you for your feedback. I did suggest to our follow-up girl that maybe we should try modifier 59 instead of XS. We found on Anthem's website that they do accept XS, XE, XU modifiers...but maybe it is still worth trying.
 
Just a thought.. and this is based on a couple of separate practices I did consults at that had the same issue. They were using different software also. The problem was the software was linking the diagnosis and in one even after the coder had linked the diagnosis correctly the software changed it. And in these instances the software was linking the first four listed diagnosis codes to each line item CPT code. This will cause a denial for incorrect medical necessity and even incorrect modifier I noticed. So be sure the linkage of the diagnosis to the line item is leaving your system correctly. I both instances we had to have the software company fix this.
 
You would have to appeal. I think BX computers doing an auto-deny even though your coding is correct. I constantly do this for DOL workman comp multiple body part claims. There's a chance when you call BX that the rep will see that the computer auto-denied and will submit the claim directly to processing.

Peace
@_*
 
We have called and gone over individual claims with rep, making sure all dx are shown and linked appropriately...and it still denies. We have also resubmitted with medical, and they continue to deny. I am at a loss. Anthem is the only one giving us problems with this.
Our follow-up girl sent an email to our provider rep and we are waiting to hear back from her. We'd like to see something in writing to show their policy. When we've spoken to reps in the past, they continue to say according to CMS 20610 should all be billed on one line. How do you bill 20610-Rt, 20610-Lt, 20610-59-Rt on one line?
 
That's incorrect because the 20610-59 is for a separate body part. Are you submitting corrective claims or doing an actual appeal form? If you're not following the appeal process, they will keep you in this infinity loop. There was a handy webinar I've done recently from Cigna or Navicure regarding this appeal issue. I wish I remembered the link.

Peace
@_*
 
What about using modifier 76 on the additional procedures?
20610 76, RT with the appropriate dx code
 
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