Wiki Modifier 50 denials

[daedolos]

Just renewed the office contract for Medicare and now we're getting denials on all injections using the modifier 50 code. What gives?

Peace
?_?

 

[Machelle Freeman]

When we bill bilateral injections we X 2 instead of the 50 or RT and LT mods. Maybe this will work for you too.

 

[daedolos]

What's the reasoning behind that?

Peace
?_?
I forgot to mention the denial code Medicare listed.


CO-16 = Claim/service lacks information or has submission/billing errors which is needed for adjudication.



99203
20610-50
J1030x2
Dx: M17.0



I don't see any errors for Medicare to gripe about.

 

[mitchellde]

What's the reasoning behind that?

Peace
?_?
I forgot to mention the denial code Medicare listed.


CO-16 = Claim/service lacks information or has submission/billing errors which is needed for adjudication.



99203
20610-50
J1030x2
Dx: M17.0



I don't see any errors for Medicare to gripe about.

Didi you use a 25 modifier on the 99203? if not they tend to pay the lesser of the charges.

 

[daedolos]

I was told that there is a guideline stating that for initial visits, there is no need to append 25 modifier. Two different, independent sources have mentioned this to me so since then, I've stopped adding 25 modifiers to initial visits.

Peace
@_*
We also have several claims denied with 99213-25 for the same reason stating CO-16 for the 20610-50. Is Medicare reverting back to 20610-LT and 20610-RT methodology?