Thursday, July 1, 2010

Insurance denial -CO- 182/CR - 182 Payment adjusted because the procedure modifier

CO- 182/CR - 182 Payment adjusted because the procedure modifier was invalid on the date of service.


 Action:   First check whether modifier has been entered at the time of charge entry. If no, then resubmit the claim with the correct modifier. If modifier has been entered but the carrier rejects the same then check whether the correct modifier has been used. If you find that the correct modifier has been used, then call the insurance and find out the reason for rejection. Based on the feedback, take corrective action. One example, Blue choice (New York) rejected a lot of claims for the reason invalid or missing modifier. Carrier was called and it was found that they do not require modifiers hence forth and claims need to be billed without modifiers.

Q: We received a RUC for the claim adjustment reason code (CARC) CO182. What steps can we take to avoid this RUC code?

The procedure code modifier submitted on your claim is not valid for the date of service billed

A: You are receiving this reason code when a claim is submitted and the procedure code(s) are billed with the wrong modifier(s), or the modifier(s) is no longer valid for the date of service billed. A clear understanding of Medicare’s rules and regulations is necessary in order to assign the appropriate modifier(s) correctly.

What is a procedure code modifier?

A modifier is a two-position alpha or numeric code that is added to the end of a Current Procedural Terminology® (CPT) or Health Care Procedure Coding System (HCPCS) code to provide additional information or to clarify the service(s) being billed.

Important Review Facts

• Before submitting your claim, ensure you use the most current year's Current Procedural Terminology® (CPT) codes and modifiers.

• Know the proper use of the CPT modifiers that exist and the appropriate use for the specific condition or situation.

• Check the claim to verify if an applicable modifier(s) is warranted and has been applied to the procedure code billed.

• Providers can utilize the Modifier lookup tool which provides information for most procedure code modifiers used by Medicare.

• If a modifier has been entered but the Medicare contractor rejects the claim, you should verify that the correct modifier(s) has been used.

Modifier 26 may be used to indicate that the professional component is reported separate from the technical component (TC modifier) for certain diagnostic test and radiology services. Codes that do not have both a technical and professional component (such as laboratory codes) should not be billed with modifier 26.

• Correct billing: The 26 modifier (professional service) may be used when billing procedure code G0202 (digital screening mammography). The listed diagnostic procedure has both a professional and technical component.

• Incorrect billing: The 26 modifier (professional service) is not permitted when billing procedure code 80048 (basic metabolic panel). The listed laboratory code does not have a professional and technical component.

• Submit separate claims for services in different years of service. A procedure code or modifier valid in one year may not be valid in the other and will cause the entire claim to reject or deny.

No comments:

Post a Comment

Popular Posts