United Modifier Update

I hate parroting things from PedTalk and elsewhere, but this one is big (and it’s a tough week). Straight from Susanne Madden, of course, is an update to a previous important announcement from UnitedHealthCare and the AAP that was made at the SF NCE:

United has decided to ‘delay indefinitely’ their implementation of the claim system enhancement that would allow for processing of multiple procedure modifiers (i.e. -25 and -59). This enhancement was first announced in the January 2007 bulletin, and was slated to be implemented in the second quarter of 2007. You will note that in the current bulletin, United is stating that its previous announcement listed an implementation date in the fourth quarter.

As soon as I get word about how this affects their previous promise to the AAP to begin these payments on December 8, I’ll let you know. We’ll even ignore the fact that it was supposed to begin at the beginning of the year.

You can see their bulletin announcing this change if you want to get angry. Note that there is no explanation for this delay whatsoever. In fact, check out the language:

Multiple Procedure Policy – Update
In the January 2007 Network Bulletin we communicated details about a system enhancement that would enable UnitedHealthcare to begin considering the codes with 0.00 Relative Value Units (RVU’s) when applying multiple procedure reductions. This proposed enhancement was targeted for implementation in the fourth quarter of 2007. The claim system enhancement that would enable UnitedHealthcare to consider the reducible codes with a 0.00 RVU has been delayed indefinitely. Please refer to the January 2007 Network Bulletin for the full details on this enhancement.

I do this stuff for a living, and I would have blown right by that – notice that there is no mention of a “-25 modifier” or anything that would catch your eye? Thanks to Susanne for knowing how to read these things.

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply