Medical Billing Forum
Billing => Billing => : dekenn May 08, 2008, 01:49:47 PM
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I recently got a claim rejected that had two procedure codes on it, with the second procedure code having modifier 59, for separate, distinct service. When I called to appeal, to Horizon BCBS, they told me that as of 1-1-08, they no longer recognize modifier 59. When asked what modifier I should use to show two separate procedures, their response was they couldn't tell me! Has anyone else heard of this?? I know you have to back up the use of the modifier, which I was prepared to do with the office notes, but not allowing it at all???
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Hi,
No I haven't heard of this. It seems very strange. I don't know how they could not recognize the 59 modifier. I would contact your BC provider rep for your area and question them. It just doesn't seem ok to not recognize a modifier that there is really no other modifier that does the same thing.
Let us know what you find out. I'm curious.
Michele
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I Bill for an ASC in Oregon, and Blue Cross of Oregon will only pay on the primary CPT code and no others, no matter what modifier I use. I don't know who your are billing for, but Modifier 59 does not work when billing B/C for an ASC
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Hello,
I work for my local BCBS and we recognize the -59 modifier, maybe the person you contacted didn't really understand what you were asking/inquiring about. That has happened to me many times we I have spoken to our Provider Representatives over the phone.
Pedenia