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Modifier Help

Annette Posted Sun 12th of March, 2017 16:59:30 PM
Blue Cross is rejecting codes for "The procedure code is inconsistent with the modifier used or a required modifier is missing" that they never did before. I am billing 99213-25, 20552-59, and 76942. What modifiers should I be using? Thanks!
SuperCoder Answered Tue 14th of March, 2017 05:32:24 AM

Greetings from SuperCoder.com!

 

There is CCI edit between codes 99213 and 20552 but a modifier is allowed. So you should report E/M code 99213 with modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service). You should not report modifier 59 with code 20552 because we have unbundled edit with the use of modifier 25 with E/M code.

 

Please feel free to write if you have any concern or questions.

 

Thanks.

Annette Posted Fri 17th of March, 2017 11:01:25 AM
Do I need a modifier for 76942? That is the one they are saying is missing a modifier.
SuperCoder Answered Mon 20th of March, 2017 03:59:14 AM

Hi,

 

Please append modifier 26 (Professional Component) with code 76942 for physician billing and then bill.

 

Thanks.

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