Marilyn Posted Mon 18th of February, 2019 15:47:25 PM
Blue Cross Community are denying our 2019 c laims: REJECT: Code 453 - Procedure Code Modifier(s) for Service(s) Rendered - Insured or Subscriber. Is there suppose to be a modifier with this new codes: 97155 & 97156. I cannot get a straigt answer from insurance. I kknow an auth is not needed.
SuperCoder Answered Tue 19th of February, 2019 09:11:59 AM
Thanks for your question.
Please provide us with the Explanation of Benefit (EOB) document which you received from payer, so that we can provide you with the correct answer for your question.
Kindly send us the EOB document on http://email@example.com
Marilyn Posted Tue 19th of February, 2019 20:41:37 PM
There's no EOB. The message is being received by the clearing house from the payer. It's not being accepted by the payer. "BLUE CROSS COMMUNITY HEALTH PLANS REJECT: Code 453 - Procedure Code Modifier(s) for Service(s) Rendered - Insured or Subscriber
BLUE CROSS COMMUNITY HEALTH PLANS Claim ID: 1904600HGS00" . Is there a modifier needed?
Marilyn Posted Tue 19th of February, 2019 21:05:15 PM
Claims are not making it to the MCO. Something about a modifier(?).
SuperCoder Answered Wed 20th of February, 2019 06:32:06 AM
As per the documentation provided, the two code i.e. 97155 and 97156 if coded together don't have any bundling issue so no modifier is needed in this scenario. Secondly, if you could provide us EOB from clearing house to identify the reason of denial and on that basis we can provide you with the list of modifiers (if needed) that can be appended with these codes.
Marilyn Posted Wed 20th of February, 2019 09:26:54 AM
There's no EOB. What I'm trying to say is that the claims are rejecting not even reaching MCO in reference to rejction code as mentioned.
SuperCoder Answered Thu 21st of February, 2019 09:30:52 AM
Our team is working on this query and will get back to you soon.
SuperCoder Answered Fri 22nd of February, 2019 09:17:31 AM
Thanks for your patience.
We are unable to find a reason, why a modifier is needed for these two codes. We have check the BCBS of NC policy for 97155 and 97156 but we were unable to find anything regarding modifier requirement. There are no CCI edits available for these two codes. We could only provide you with this limited information about this rejection after discussing with the SME's as well.