Judy Posted Tue 14th of February, 2017 16:30:13 PM
We have been getting a lot of denials back from MHS and MHS-HIP for invalid modifier, when the claim had only the QS modifier. We have been under the impression, for quit some time now, that MHS did not accept the AA or QZ modifier. Do you know if we are incorrect in our thinking. I've placed several calls to MHS, but they will now let me talk to their coding department. Here is how we have been billing for Medicaid in regards to the AA and QZ modifier
IPA - no AA
MHS - no AA or QZ
MDWise - no AA
Standard - no AA
Can you please help?
SuperCoder Answered Wed 15th of February, 2017 06:38:08 AM
Could you please let me know, which procedure did the provider performed and what CPT code was billed for the procedure?
What all modifiers did you append with Anaesthesia CPT Code?
What did the insurance company stated in the denial?
As per your specific payer, was any pre- authorization required?
Judy Posted Wed 15th of February, 2017 08:22:21 AM
We've had several. 1 that I am working on right now was CPT 00142, it was for a Cataract. It was billed with a QS modifier. The provider was a CRNA. The insurance is MHS. The denial just said invalid modifier. Insurance was called and no precert was required.
The other 1 I'm dealing with right now was CPT 00810, it was for a Colonoscopy. It was billed with a QS modifier. The provider was a CRNA. The insurance is MHS HIP. The denial just said invalid modifier. The procedure was precerted.
SuperCoder Answered Thu 16th of February, 2017 05:27:53 AM
As per your mentioned CPT codes 00142 and 00810, both the services can be performed by CRNA and are eligible to be billed with QS modifier.
The reason for denial can be due to the payer specific reason. Kindly check with your respective Payer regarding the same.