Health Information Management

Tip of the Week: Follow Transmittal AB-03-114 to avoid denials

APCs Insider, January 4, 2008

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Consider the following scenario: A physician performs a screening colonoscopy and, because of poor prep, asks the patient to come back when the prep is complete.

Have you ever appended modifier -53 for the first screening, but received denials on the second screening?

In order to alleviate the denial, refer to Transmittal AB-03-114. Fax this transmittal along with a copy of the report directly to the payer. Explain that this is what the national guidelines tell you to do and ask why it isn't working and how you need to change. Note that modifier -53 is just for the professional side. To view Transmittal AB-03-114, click here.

(The above tip was excerpted from the December issue of Briefings on APCs).



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