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Sunday, April 3, 2011

MISSED TO UPDATE NEWLY REPLACED MODIFIER ON CLAIMS

DESCRIPTION OF THE ISSUE
During 2010 modifier AY (Item or service furnished to an ESRD patient that is not for the treatment of ESRD) was billed along with CPT 82947.  This modifier was replaced by CB (Service ordered by a Renal Dialysis Facility (RDF) physician as part of the ESRD beneficiary’s dialysis benefit, is not part of the composite rate and is separately reimbursable) effective from Jan 2011.  Claims were filed incorrectly with old updates for the year 2011.

CONCEPT
Coding updates should be verified for most frequently used procedures for any practice so that we have our claims filed with new and appropriate updates for the concerned year.

SOLUTION
On receiving ‘incorrect modifier used’ denials we analyzed procedure updates and modifier updates and started refiling the denied claims with correct modifiers.

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