Author Topic: CPT MODIFIER CODES FOR UHC  (Read 2471 times)

sarac4h@gmail.com

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CPT MODIFIER CODES FOR UHC
« on: October 16, 2014, 04:30:19 PM »
I have received EOB's for all of my UHC patients with error codes for the modifiers being wrong on codes
97112, 97110, and 97140. The typical modifiers we use are 59 & 52. They are telling me to take one off, but I am not finding anywhere on there website where it shows that change. The modifiers are for totally seperate purposes and would be committing insurance fraud without both of them there. Has anyone else had this problem with these CPT code modifiers with UHC in the last couple of months?

About to pull my hair out!

Sara

kristin

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Re: CPT MODIFIER CODES FOR UHC
« Reply #1 on: October 16, 2014, 10:00:26 PM »
Do you think it has something to do with putting a 52 modifier on these particular codes, since they are all timed codes? If you do them each for eight minutes, you don't need the 52. Could it be that UHC has decided that doing any of them or all of them less than eight minutes each doesn't warrant billing them at all, thus they won't accept the 52 modifier for reduced services?

I don't bill PT or chiro, so I don't really know, just throwing it out there as a possibility. Have you asked UHC which modifier is the problem one?

DMK

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Re: CPT MODIFIER CODES FOR UHC
« Reply #2 on: October 17, 2014, 10:05:20 AM »
-52 should be removed.  -59 indicates that there was an additional separate service to the main service.  -52 means something stopped the completion of the service.

Ryanne

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Re: ANOTHER QUESTION REGARDING UHC THERAPY CODES
« Reply #3 on: November 13, 2014, 08:07:04 PM »
I also bill for therapy with UHC - about a year ago (or more)  they started changing the CPT codes on the EOB's - I've called quite a few times and asked for corrected EOB's so I could file secondary insurance.  But they are still doing it.  At first it was just for speech - changing 92507 to 99217 and the same for 92526, changing it to 99217.   Now they are changing PT CPT codes too 97110, 97112, 97116 changing to 99217.  They don't seem to think it's a problem and obviously have no intention of fixing it. Also they divide up claims - sometimes paying on one unit, then other units (same day charges) on the next EOB.  This is all so frustrating.  Our EDI system populates only the first payment - so other units are not posted.  Of course, I go in and fix each claim and enter the payments manually, but when all are the same wrong code, it's very time-consuming.   I have never really gotten an answer as to why they are doing this or why they do not use the codes that were submitted.  Does anyone else have a problem with this?  I find it SO annoying.  And it's not all the time - I mean changing the CPT codes to 99217- some are paid showing the correct code.

kristin

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Re: CPT MODIFIER CODES FOR UHC
« Reply #4 on: November 13, 2014, 11:14:46 PM »
So UHC is changing various therapy codes that are being billed, to 99217 instead, which is a hospital observation discharge code? How is that even in the same ballpark, what are they thinking? Have you contacted your UHC provider relations rep to discuss this? Not the regular UHC representatives, but your actual provider relations representative, because I would definitely do that, if you haven't already.

Ryanne

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Re: CPT MODIFIER CODES FOR UHC
« Reply #5 on: November 20, 2014, 01:28:29 AM »
Yes, I've looked up the code 99217 and it says the hospital discharge code.  I've called UHC numerous, numerous times and they do not seem to have an answer.  I agree, it doesn't make sense. Was wondering if other billers have come across this problem.   A lot of our patients have Medicaid as a secondary insurance, but now I can enter secondary online without the EOB.   However,  it makes me SO mad that they keep changing the CPT codes.  Takes me forever to figure out the EOB's for patients that have OT and ST, and only parts of dates of service are paid per EOB.

shanbull

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Re: CPT MODIFIER CODES FOR UHC
« Reply #6 on: November 20, 2014, 12:52:21 PM »
That kind of code changing is crazy  :o Downgrading to a lesser service happens all the time (e.g. 98941 downgraded to 98940) but to switch to something totally unrelated?! That is bizarre. What happens when you appeal? I've also never heard of splitting units on EOB's. CPT codes, sure, but units? That makes no sense whatsoever. I bill some of those codes too (97110 and 97112) and have not run into either of these issues.