Anybody else having problems with BCN paying for more than u/s (code 76805).
Pt had u/s done on 9/16 to confirm her pregnancy, on 10/7 she had another one for 20 week and then on 10/21 for a follow up due to fetal abnormality. BCN is denying stating the clinical editing rules define the procedure code, modifier or place of service as inappropriate for the reported service. I called BCN informed them there's no modifier on the claim, and they stated they would resend the claim to the correct department. I just received another RA and it states the same thing. I called them again and this time they couldn't help me out. I've never had to put a modifier on any of my claims for u/s. Any suggestions would be appreciated.
Help
Pt had u/s done on 9/16 to confirm her pregnancy, on 10/7 she had another one for 20 week and then on 10/21 for a follow up due to fetal abnormality. BCN is denying stating the clinical editing rules define the procedure code, modifier or place of service as inappropriate for the reported service. I called BCN informed them there's no modifier on the claim, and they stated they would resend the claim to the correct department. I just received another RA and it states the same thing. I called them again and this time they couldn't help me out. I've never had to put a modifier on any of my claims for u/s. Any suggestions would be appreciated.
Thanks
Help
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