Wiki Blepharoplasty 15823

[smp.md@live.com]

I work for a health insurance company and reviewed a claim denial today with a provider for the facility and this is a medicare replacement plan *** they billed 15823 LT and 15823 RT ** the surgon also billed 15823 LT and 15823 RT was paid and the facility claim was denied as units maxed *** the auth on file is for the facility *** this was billed on a UB04 *** can you explain why the facility claim was denied. I looked in the Medicare Guidelines and the CCI and could not find an answer.

 

[mitchellde]

Perhaps they should have used the eyelid modifiers. E1,E2, E3, E4 are specifically outpatient and ASC modifiers.

 

[ABonnell CPC]

Its probably some rule they have in their claim editing software, and/or something about the way the claim was processed. The facility will need to call and get it straightened out. Have the claim sent back for reconsideration or appeal. I've had this happen a couple of times with the professional claim. It was just the way the insurance processed the claims.

 

[smp.md@live.com]

Blepharoplasty

Thank you for both of your answers, they both helped.