An internal system
processing issue has caused some surgical procedure codes billed with modifier
22 processed on/after January 1, 2014, to not allow any additional money above
the fee schedule. First Coast Service Options (First Coast) is currently
identifying the impacted claims and will begin to initiate adjustment action on
all impacted claims within the next two weeks. Note: only claims previously
reviewed by our medical staff having met medical necessity requirements to
allow above the fee schedule will be adjusted. Providers are asked not to file
appeals or call the First Coast call center regarding this internal issue.
First Coast apologizes for any inconvenience this issue has caused.
Issue
An internal system processing issue has caused some surgical procedure codes
billed with modifier 22 processed on/after January 1, 2014, to not allow any
additional money above the fee schedule.
Resolution
First Coast is currently identifying the impacted claims and will begin to
initiate adjustments on all impacted claims within the next two weeks. Claims
having met medical necessity requirements will be changed to an unlisted
surgical procedure code (modifier 22 will be appended to the related unlisted
surgical procedure) to allow payment above the Medicare physician fee schedule.
First Coast began utilizing this process July 11, 2014, for all surgical
procedure billed with the 22 modifier that met medical necessity requirements
for additional payment.