ollielooya
True Blue
Yes, I know this is a public forum...but I'm so tired of Customer Service Insurance Reps telling us that they cant tell us how to bill or code (duh!) when requesting their preferences on modifier format when submitting 1) multiple injections, and 2) bilateral charges on the HCFA. I just got off the phone with MCD Nevada
Multiple injections = 1 line with units. I know there have been discussions before thruout the forum, but every single educational reference I've read always recommends that the billers lst call the insurance companies to inquire about modifier format preferences only to receive the typical response: "not being able to help with billing/coding issues". So if there are 3 separate injections, does the insurance company prefer one line with one unit, to be followed by 2 separate additional lines w/mod 59 or one line with 3 units and modifier 59 (depending on situation of course). Is not this a reasonable question?
Here's another one: bilateral billing preferences. MCD NEV: We're told to follow MCR guidelines. Then if we follow their guidelines we bill one unit with modifier 50. We do not need to utilize two lines with RT and LT and 1 unit for each? Oh, but it's ok to use modifier 51 for multiple procedures even if MCR doesn't? Can someone please define "consistency?"
I requested a published document from MCD NEV to validate this information and the ensuing response was that my request was skating a fine line and this type of information is not supplied. So I gently pressed the rep to please follow up with written confirmation of the advice received. Nope, they won't do that either. How confusing can this get?
Again, I'm venting....but could someone could supply a blanket or generic statement as to how to ask an insurance company their preferences in submitting bilateral modifiers and the use of UNITS when billing multiple injections?
Hopefully any responses generated will be benefical to all. Sometimes I wish I could look at this thru the eyes of the insurance company in order to make the process more efficient. So if any of you have worked from that end, please share your thoughts!!!
Suzanne E. Byrum CPC
Multiple injections = 1 line with units. I know there have been discussions before thruout the forum, but every single educational reference I've read always recommends that the billers lst call the insurance companies to inquire about modifier format preferences only to receive the typical response: "not being able to help with billing/coding issues". So if there are 3 separate injections, does the insurance company prefer one line with one unit, to be followed by 2 separate additional lines w/mod 59 or one line with 3 units and modifier 59 (depending on situation of course). Is not this a reasonable question?
Here's another one: bilateral billing preferences. MCD NEV: We're told to follow MCR guidelines. Then if we follow their guidelines we bill one unit with modifier 50. We do not need to utilize two lines with RT and LT and 1 unit for each? Oh, but it's ok to use modifier 51 for multiple procedures even if MCR doesn't? Can someone please define "consistency?"
I requested a published document from MCD NEV to validate this information and the ensuing response was that my request was skating a fine line and this type of information is not supplied. So I gently pressed the rep to please follow up with written confirmation of the advice received. Nope, they won't do that either. How confusing can this get?
Again, I'm venting....but could someone could supply a blanket or generic statement as to how to ask an insurance company their preferences in submitting bilateral modifiers and the use of UNITS when billing multiple injections?
Hopefully any responses generated will be benefical to all. Sometimes I wish I could look at this thru the eyes of the insurance company in order to make the process more efficient. So if any of you have worked from that end, please share your thoughts!!!
Suzanne E. Byrum CPC