182: Procedure modifier was invalid on the date of service

On Call Scenario:

                                                   Claim denied as procedure modifier
                                                     was invalid on the date of service
                                                                              ↓
                                                           May I get the denial date?
                                                                              ↓

                                             Check patient payment history if the same

                                                 CPT code paid with the same modifier

                                                  ↙                                                          ↘
                                             Yes                                                             No
                                               ↓                                                                ↓
                  Can you please reprocess the claim as                What is the time limit to 
             payment received for same CPT & modifier?            send corrected claim?
                                               ↓                                                                ↓
                     What is the TAT for reprocessing?                 What is the Fax# or Mailing 
                                               ↓                                              address to send an appeal?
                      May I have the claim# & call ref#?                                  ↓
                                                                                              How much is the time limit 
                                                                                                    to send an appeal?
                                                                                                                ↓
                                                                                         May I have the claim# & call ref#?

Important Note:

• This denial should be assigned to the coding team to review and provide the correct modifier and once a response is received with the correct modifier details then send corrected claim to insurance by updating correct modifier even if the time limit to send correct claim is crossed.
• If the coding team states that the modifier is correct then send an appeal to insurance.
• When sending an appeal, calculate the time limit from the denial date, if it is not crossed then send the appeal or else write off the claim if the time limit is crossed.
• Sometimes the client wants us to send the appeal even if the time limit is crossed, so work accordingly.
• There will be a scenario where same CPT billed with LT and RT modifier and one of them is already paid and other denied as invalid modifier, in that scenario insurance needs to send the CPT in a single line by using bilateral modifier(50). So void both the CPT and create new line with a 50 modifier which will double the charge amount and send corrected claim to insurance.
• Medicare does not accept the corrected claim, so first send the void claim for paid CPT to insurance then send a new claim with a 50 modifier.

Prepare Notes:

Source of Status:

* Call Website EOB System

Clearing House Comment (Please make the changes if required):

Insurance Name:

*

Clearing House Name:

Insurance Phone#:

*

Rep Name:

*

Website Name:

*

Denial Date:

*

Has payment found for the same CPT with same modifier in the patient payment history?:

* Yes No

What Information is Available?:

* Corrected Claim Time Frame Appeal Information Corrected Claim Time Frame and Appeal Information None

TAT for Reprocessing:

*

Corrected Claim Time Frame:

*

Mode of appeal:

* Fax Mail Website

Fax Number:

*

Mailing Address:

*

Website Link:

*

Appeal Limit:

*

Additional Comment:

Claim Number:

*

Call Reference#

*

Action:

* Need coding assistance Updated correct modifier and resubmitted the claim Updated correct procedure and resubmitted the claim Need client assistance Need to send an appeal Need to allow time Appeal Sent



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