Wiki Which modifier?

[debiwill]

I have had a claim for monthly peritoneal dialysis (90966) denied by Noridian Medicare for "missing or invalid modifier". I've not heard we need a modifier for this. I've researched the Noridian Medicare website, but have no idea which modifier my provider should be using. Any help would be appreciated! Thank you!
Debie

 

[btadlock1]

I have had a claim for monthly peritoneal dialysis (90966) denied by Noridian Medicare for "missing or invalid modifier". I've not heard we need a modifier for this. I've researched the Noridian Medicare website, but have no idea which modifier my provider should be using. Any help would be appreciated! Thank you!
Debie

Did you bill it by itself? And was your provider a regular doctor, or an NPP?

 

[btadlock1]

This may have your answer: http://www.cms.gov/MLNMattersArticles/downloads/MM6782.pdf

It talks about G1-G6 modifiers, and V8 and V9...

Without knowing anything about the encounter, I'd guess that they're wanting V9 (No dialysis-access related infection, as defined for modifier V8, present during the billing month)

Hope that helps!

 

[debiwill]

Thanks Brandi,

The code is billed by itself & my physician is a Nephrologist. I read about those modifiers, but it is so vague

Thanks for your help, I greatly appreciate it!

Debie

 

[btadlock1]

Thanks Brandi,

The code is billed by itself & my physician is a Nephrologist. I read about those modifiers, but it is so vague

Thanks for your help, I greatly appreciate it!

Debie

Try calling customer service and telling them that you're confused about the denial...Ask them if the code would have been payable, if you had submitted it with the V9 modifier. You'll have to be really careful about how you word your questions; they can't tell you how to bill, so if you seem like you're just randomly fishing for answers, they'll shut down and tell you that they can't help you at all. You kind of have to lead them with your questions - like you already know what the answer is, but you just need them to confirm it for you. Be really nice, and sound as clueless as possible, but make sure to mention specific CPT codes and modifiers by name.

If you can't get an answer that way, ask them:
1. Why a modifier is required on that code - if they reference an LCD/NCD, ask for the specific policy # so you can look it up.
2. If they tell you that it's bundling, find out what it's bundling to.
3. Make sure and confirm whether "Incidental/Inclusive" means global, bundled, or mutually exclusive.
You should be able to figure out what they want if you can find out the answers to those questions. Hope that helps!