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Thread: Billing Cataract After Care Anthem

  1. #1
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    Billing Cataract After Care Anthem

    This is my first post, and I'm really hoping that someone will be able to help me. I have been fighting with Hawaii Anthem for almost a year on the after care claims for a patient. I have put on the cataract ICD-9 code with modifiers 55 and LT on the claim, but they keeping telling me that my modifiers are wrong. I have to have both of those modifiers or the claim will be processed incorrectly. If someone has any tips for me I would greatly appreciate it.

  2. #2
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
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    What do you have as Diagnosis? V43.1?

    Most post op co-management claims will have you use 12 as place of service, but a few will tell you to use 11.

    Have you been able to talk with someone there to find the specific issue they have?

    Does your dates of service, and codes match the ones submitted by the surgeon?

    Are you listing 55 as the first modifier, and then LT for the second mod?
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  3. #3
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    Quote Originally Posted by Jubilee View Post
    What do you have as Diagnosis? V43.1?

    Most post op co-management claims will have you use 12 as place of service, but a few will tell you to use 11.

    Have you been able to talk with someone there to find the specific issue they have?

    Does your dates of service, and codes match the ones submitted by the surgeon?

    Are you listing 55 as the first modifier, and then LT for the second mod?
    I have 366.16 as my diagnosis. I haven't been able to receive a straight answer from any of the multiple foreign people I have talked to, the most I get is that my modifiers are "wrong" and when I try and ask why/how they tell me at they are not allowed to help me with that. My dates and codes are the same as the surgery and I am listing the modifiers in the 55LT order.

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    I've been using z96.1 for post- op cataract on the IDC-10. It' takes so long to get paid, IDK if it's right yet.

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