Wiki Bundling-Modifiers

[kboyd22]

What modifiers are being used for bundling issues on 45385 & 45380(separate areas/polyps) and now on 43249 & 43239. These are all bundled but modifiers allowed however they all also have multiple procedure/endoscopy indicator of 3. We have always used a 59 on the 45385 & 45380 but now it is denying as invalid modifier combo. I can't figure out if they are wanting the X modifiers or if they are wanting the 51. ( I am trying to determine for ALL payers, Medicare and Commercial).

Any thoughts on this would be appreciated.

 

[jsmooney6219]

I would like to know too- I am having XS modifier denials (initially 59 modifier denied) on colonoscopies w/multiple bx on diff parts of colon- this just started happening

 

[kboyd22]

any resolution

Has anyone found a resolution to the 59 modifier being denied by BCBS?

 

[GI CODER]

It could be an updated payment policy at the insurance company. For instance, MVP Insurance updated their Multiple Endoscopies Payment Policy effective 1/1/2018 for endoscopies in the same family of codes. They will pay the higher priced procedure code, and consider the other procedure payment included in the primary payment. You might want to ask the insurance company for a hardcopy of their payment policy for multiple procedures.