daboronda
Contributor
I know I can't use this modifier, but what should I use. Benign scalp excision 11422 with layered closure 12031, done in ASC due to young age. I'm at a loss. Thanks for the help.
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Wiki Modifier 23 for ASC
- Thread starter daboronda
- Start date
mbort
True Blue
why do you feel you need to use a modifier?
daboronda
Contributor
These codes are not payable in an ASC by Medicaid.
mbort
True Blue
there are no appropriate modifiers that will bypass Medicaid. I'm afraid that your ASC will end up "eating" this case.
tgutierrez
Networker
I would bill the codes without the modifier and if (or when) the claim denies attempt an appeal/reconsideration with a letter explaining the special circumstances as to why it had to be done in an ASC. Maybe even a letter from the surgeon would help.
Good luck.
Good luck.
mitchellde
True Blue
I really doubt that that will work, if they are not ASC approved then it should have been performed in a hosp outpatient OR or physician office. I agree with Mary there is no way to override this. The list of non approved ASC procedures is well published and this would have been set up as an elective procedure so the physician could have been informed that this could not be performed in your facility.