MILD Billing

[swamprat]

Just started doing some MILD procedures for my vertiflex denials (Medicare advantage plan situation apparently they are "in court").

The code is 0275T however when I select that my EMR auto adds the modifier Q0. I can remove it - but do I? How do you guys bill and get paid for MILD procedure

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[Sig123]

Just started doing some MILD procedures for my vertiflex denials (Medicare advantage plan situation apparently they are "in court").

The code is 0275T however when I select that my EMR auto adds the modifier Q0. I can remove it - but do I? How do you guys bill and get paid for MILD procedure

We’ve found billing MILD is a bit challenging and often ends up requiring resubmitting claims as they get denied for various reasons off the bat.

The Q0 (zero) modifier is necessary as it denotes that the code is part of a clinical trial, in this case a post-procedure claims trial that Vertos is doing per Medicare requirements.

Here are some tips:

M48.062 -Lumbar Spinal Stenosis with Neurogenic Claudication. Must be primary diagnosis.

Z00.6-Health Status Code-Encounter for examination for normal comparison and control in clinical research program. Must be secondary diagnosis.

Q0 (Q-zero) modifier-Approved clinical study

Clinical Trial Number-03072927. This must go in the claim.