Wiki E0971 denied for Modifier doesn't match DX

[awnw211@yahoo.com]

Hello, I'm hoping someone can help me with an issue I'm having for HCPC E0971 wheelchair anti-tippers. The insurance requires these items to bill with LT and/or RT modifiers. The issue I'm having is we're getting denials when the Dx is specific to one side of the body-such as a fracture to the left hip, because the RT modifier doesn't coincide with the Dx. The E0971 is normally applied to both the left and right side, in the front or the back, of the wheelchair to prevent it from tipping over forward or backward, not side to side. The LT left RT right side the item is applied to shouldn't need to coincide with the side the injury has occurred on. My first level appeal was already upheld and I'm not sure how else I can get this point across.

 

[iowagirl77]

Are you certain they want the LT/RT modifiers on E0971? When I look up this code in an encoder, it doesn't show those modifiers as options.

 

[awnw211@yahoo.com]

Are you certain they want the LT/RT modifiers on E0971? When I look up this code in an encoder, it doesn't show those modifiers as options.

A rep with the insurance said they were required, but I have trial claims pending that we submitted without them to see if that works. I was just wondering if anyone had come across a similar issue and knew how to correct it in the meantime. hopefully the trial claims will be paid.