Some of you may know, others not, what I do for a living. I work processing Medicaid for the state. That’s the short version of what I do. The longer version is that I make sure the procedure, diagnosis, revenue, modifier codes are on file correctly, restricted correctly, and make sure that we have limitations in place for these codes (like only one dental cleaning per 6 months). I make sure claims suspend for this correctly, and write up the instructions for other employee’s to follow when manually reviewing claims. I also deal with the state on a regular basis.
So part of what I do is look at claims that have suspended for a few reasons. One is procedure code/modifier combo not on file. A procedure code is what was done (physical) or an item (wheelchair) that was given. A modifier tells something additional about the procedure code (like if it was a procedure on the left arm, someone would bill with LT modifier, that indicates left). So these combinations (the procedure code and the modifier) need to be put in our system, if they’re valid, and I do that. I also deny claims billed with invalid combo’s.
Back to the story. I’m working these claims. Pretty easy stuff. I come to a claim were the provider has billed a T procedure code (t4534 or something). It’s for “adult sized disposable incontinence products”. Now I work with these claims and see all kinds of things here, so it
doesn’t phase me at all. However, it’s the modifier the provider bills with this code. NU. Do you know what this modifier means? New. It means ‘New’ product. As opposed to UE (used) and RR (rental).
Does the provider think we’re stilling here wondering if he’s giving out new diapers or not? Does he really think we’re questioning “I wonder if these are rental diapers or not…they don’t say…”?
I know what you’re thinking… “Tiffany, maybe they’re cloth diapers and briefs and pads.” Well, if that is the case, they would not be listed as ‘disposable’. These codes are pretty specific. And even still, I don’t know that I would accept a rental or a used cloth diaper. Sorry. :P
So part of what I do is look at claims that have suspended for a few reasons. One is procedure code/modifier combo not on file. A procedure code is what was done (physical) or an item (wheelchair) that was given. A modifier tells something additional about the procedure code (like if it was a procedure on the left arm, someone would bill with LT modifier, that indicates left). So these combinations (the procedure code and the modifier) need to be put in our system, if they’re valid, and I do that. I also deny claims billed with invalid combo’s.
Back to the story. I’m working these claims. Pretty easy stuff. I come to a claim were the provider has billed a T procedure code (t4534 or something). It’s for “adult sized disposable incontinence products”. Now I work with these claims and see all kinds of things here, so it
doesn’t phase me at all. However, it’s the modifier the provider bills with this code. NU. Do you know what this modifier means? New. It means ‘New’ product. As opposed to UE (used) and RR (rental).Does the provider think we’re stilling here wondering if he’s giving out new diapers or not? Does he really think we’re questioning “I wonder if these are rental diapers or not…they don’t say…”?
I know what you’re thinking… “Tiffany, maybe they’re cloth diapers and briefs and pads.” Well, if that is the case, they would not be listed as ‘disposable’. These codes are pretty specific. And even still, I don’t know that I would accept a rental or a used cloth diaper. Sorry. :P
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