Wiki How to get 17262 paid

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ssevans78

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I have a claim that was first billed like this 17262, 17262 mod 76, 17000. BCBS came back and only paid the 17000 and states on the 17262 service is incidental or mutually exclusive to the primary procedure. Coding practice is inconsistent with current NCCI coding protocols. Amount is provider write-off.

So when I got this back I realized that the system generated the wrong modifier to the code so I sent the claim back and coded it as such 17262 modifier 50 unit 1 because the procedure was done 0.8 cm left superior shoulder and the other was done on 0.7 cm right posterior shoulder. But insurance came back and denied again stating this time. Procedure code/modifier combination is invalid per coding conventions. Amount is provider write off.

Can you tell me the best way to code this?
 
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You do not use a 76 modifier on codes performed on two different locations. A repeat procedure would be like an ekg performed and then on the same day at a different time an ekg is performed again. The same procedure performed at a different session. You do not use the 50 modifier for skin procedures as skin is one organ with no lateraling, you should try the 59 modifier or the XS depending on the payer. This would indicated a procedure performed at a separate site in the same session.
 
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I knew that the 76 was incorrect when the claim came back denied by Blue Cross Blue Shield. Our system autogenerates the modifiers and this one was missed before being sent out.

so that is why I changed it to modifier 50 thinking because it was two different sites.

But that does make sense that the skin in one organ.

So since it is blue cross blue Shield do you think modifier 59 would be better than the XS because that Cleary states separate organ/structure.

Thanks for the help so far.
 
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59 is the old standard and should work. Just check with the payer as some commercial have switched over to the X modifies in place of the 59 and in that case the XS would be the one to chose.
 
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