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Old 07-17-2013, 06:52 PM
jessica1974 jessica1974 is offline
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We recently received a refund request from Humana asking for money back from 2012. Seems like they are applying a multiple reduction when we billed a LHC & a stent. It appears like they are adding a 51 modifier to the heart cath. Does anyone know if we should be appending it? I want to keep from having any more requests from them.
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Jessica Chandler CPC, CPC-H, CPC-P, CCC
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Old 07-18-2013, 01:27 PM
Jess1125 Jess1125 is offline
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Originally Posted by jessica1974 View Post
We recently received a refund request from Humana asking for money back from 2012. Seems like they are applying a multiple reduction when we billed a LHC & a stent. It appears like they are adding a 51 modifier to the heart cath. Does anyone know if we should be appending it? I want to keep from having any more requests from them.
According to the Medicare Physician Fee Schedule the multiple surgery indicator for the cardiac cath codes is "2" which means that, yes, multiple surgery reduction would apply.

Jessica CPC, CCC
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Old 07-19-2013, 12:58 PM
Jim Pawloski Jim Pawloski is offline
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Quote:
Originally Posted by jessica1974 View Post
We recently received a refund request from Humana asking for money back from 2012. Seems like they are applying a multiple reduction when we billed a LHC & a stent. It appears like they are adding a 51 modifier to the heart cath. Does anyone know if we should be appending it? I want to keep from having any more requests from them.
Try modifier-59 with the heart cath code, as long as the LHC was diagnostic and not guiding shots.

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Jim Pawloski, CIRCC
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