Wiki Anthem denying 73502 RT

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jeskla

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Hello everyone,
We have been adding the RT/LT modifier to the 73502, but Anthem is rejecting the claim stating invalid modifier. Our biller is calling Anthem tomorrow, but I was hoping to get your opinion. Should we not use RT/LT because the hips are considered one body area? If no, what about the shoulders, we have always billed those with RT/LT and never received a denial? Please help.
 
I'm thinking since there are separate unilateral and bilateral codes for hips that its not required vs a shoulder which doesn't have a bilateral code
 
I am interested in what Anthem tells you when you call.
73502 is a unilateral code which would require modifier RT or LT.
 
I am in Virginia and am now having an issue with an Anthem ACA plan denying 73502 with Rt as modifier. I just got off of the phone with Marie with ACA Anthem plan. According to her, they are using McKesson software for coding and edits. Per this software, the 73501-73503 codes will not be processed with the RT/LT modifiers.
with that said, I have removed the modifier and sent an electronic 151 through Availity to have 73502 reprocessed for payment.

Ironically, Anthem PPO does not use the McKesson software and is not denying these claims with the RT/LT modifier nor have I experienced this issue with any other payer so far.
 
73502

Review diagnosis, if the diagnosis is specific to RT/LT then the modifier is not required and will deny for invalid modifier.
Hope this helps.
 
I am also having trouble with Anthem denying 73502- but because of the TC modifier. When I called, I was told that this wasn't a valid modifier per CMS guidelines. They of course couldn't tell me the guideline number. Has anyone else had a problem with TC?
 
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