denied payment stating "The procedure code is inconsistent with the modifier used or a required modifier is missing".
I called Medicare and the rep tells me "according to Medicare guidelines, modifier -79 is an invalid modifier for the procedure code I billed"……….WHAT ???
I explain the patient is in a post-op period, the patient received an injection into the carpal tunnel of the arm that did not have surgery which would make the injection unrelated to the post-op, I read the definition of modifier 79 "Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period"…………then she says "according to Medicare guidelines, modifier -79 is an invalid modifier for the procedure code I billed". That’s all she keeps telling me and I just can’t with her any longer. This has happened once or twice before too and we never got paid.
Am I missing something??? Am I the only one this has happened to??? Please HELP!
Thank you
Jen