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The Eight Circuit Court of Appeals upheld a lower court’s ruling regarding out-of-network payments by UnitedHealthcare (UHC). How Ruling Got Started UHC has a policy of offsetting payments for patients in a different plan when they are trying to recover what they considered an overpayment. These policies were put into effect in 2007 and were […]
The post Court Upholds Ruling in UnitedHealthcare Out-of-Network Case appeared first on AAPC Knowledge Center.
UnitedHealthcare (UHC) has issued a clarification to its Skin and Soft Tissue Substitutes medical policy (2018T0592A) in regards to DermACELL®. Behind the Decision DermACELL® (LifeNet Health®) is advanced human acellular dermal matrix intended for the treatment of chronic wounds and soft tissue reconstruction such as implant-based breast reconstruction. A recent report for DermACELL concluded that the […]
AAPC Knowledge Center
In August 2017, UnitedHealthcare (UHC) indicated they would no longer reimburse inpatient and outpatient consultation codes as of Oct. 1, 2017. When the implementation date came on Oct. 1, 2017, UHC indicated they delayed the consultation services revision until 2018: We previously announced that certain revisions to the Consultation Services Reimbursement Policy would become effective […]
AAPC Knowledge Center
United Healthcare doesn’t like modifier 76 for a repeat surgical procedure when billed in a postop period of a previous unrelated service which also requires modifier 79
For example…
UHC has no problems billing this…
11401
11401 -76 (repeat excision)
No problem billing this…
11401 -79 (excision billed in a 10 or 90 day postop period of a previously unrelated procedure)
UHC doesn’t like this.
11401 -79
11401 -76 -79 (they don’t like 76 and 79 on the same line)
The second is excision is a repeat procedure and is also in a postop period for a previous unrelated service. Both modifiers are appropriate. They will pay the first, but not the second.
What’s the best way around this? Modifier 59 isn’t appropriate as they aren’t bundled procedures according to the NCCI edits.
There are other carriers that don’t like 76 and 79 together, but UHC is a biggie.
What say ye?