Wiki Humana denial

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tmarugg

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Our patient underwent carpal tunnel surgery. Humana has denied the claim stating a modifier is required for this procedure. The other coder in our office & myself were discussing the fact that since ICD-10 has expanded diagnosis codes (like this one) to included specific location, is a modifier still required? Our ICD-10 code indicates right wrist.

This issue has never occurred to us.

Thanks in advance for your thoughts on this.
 
tmarugg said:
Our patient underwent carpal tunnel surgery. Humana has denied the claim stating a modifier is required for this procedure. The other coder in our office & myself were discussing the fact that since ICD-10 has expanded diagnosis codes (like this one) to included specific location, is a modifier still required? Our ICD-10 code indicates right wrist.

This issue has never occurred to us.

Thanks in advance for your thoughts on this.
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No changes were made for laterality modifier usage for CPT. You'll still need to use LT/RT for the codes that have required it in the past. And actually, Humana seems to be getting stricter with this requirement in the year, it seems.
 
If it's Humana, they'll still want anatomical modifiers.
I agree modifiers should still be added where appropriate no matter the changes with ICD10. In my experience, Humana always seems to be (for lack of a better word) more strict compared to other payers. If the anatomical modifier is missing for a patient with another payer, that claim might still be reimbursed/allowed. The same claim/coding for a patient with Humana often won't get past their claim edits.
 
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