Modifier Requirement for Coding Appeals
May 20, 2015In order to ensure consistency with Medicare Correct Coding Initiative (CCI) edit requirements, Blue Cross and Blue Shield of Minnesota (Blue Cross) will be changing responses to certain coding software appeals effective July 1, 2015. Currently, for commercial business coding software appeals, if a service is determined to be allowable based on appeal documentation, that service may be allowed regardless if the appropriate modifier was submitted with the appeal. This applies primarily to services that require a -24, -25 or -59 modifier. For all commercial business coding software appeals received on and after July 1, 2015, if a service requires a modifier and that modifier is not submitted with the appeal, the service denial will be upheld regardless if the documentation supports allowing the separate service.