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#1 Posted : Wednesday, December 23, 2020 1:46:21 PM(UTC)

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Joined: 9/3/2014(UTC)
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I work in the billing department and oddly enough until now I've never had this issue. How do I bill two separate codes each with their own authorization number? Do I put both on the auth line? Patient came in and picked up their OA (E0486) but also had a CBCT (70486). I have a gap exception auth for E0486 and I have a separate pre-auth (not gap) number for 70486. I don't think it matters but both auths were obtained from different places/companies. Also does this get a modifier 51 or 59 or does that not qualify since one is for DME? Using DW to bill. Thank you for your help!

#2 Posted : Tuesday, December 29, 2020 9:09:50 AM(UTC)

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Hi Aurora!

Great question! It should not matter that auth & gap were obtained from different places, many insurers outsource those services these days! Here's what I would do as far as putting them both on the claim:

Go ahead and put the authorization approval number in field 23.
For the gap exception, enter that approval number into field 19, and indicate it is for the E0486

You certainly could put them on separate claims as well, but doing it as described above should do the trick :) And good thinking on the modifier 51 & 59, however as you mentioned, i don't think it's appropriate for this scenario, so just be sure to use your usual modifier on the E0486! (modifier NU).

Hope this helps!
#3 Posted : Thursday, December 23, 2021 11:33:24 PM(UTC)
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