Cardiology Coding Alert

Reader Question:

Check 93641 Modifier 51 Exempt Status

Question: I have a question from the May 2016, vol. 19, no. 5, Cardiology Coding Alert, about the question "Break Programming Out of Global." You mentioned that on the day of an ICD implant we can bill 93641 which we will bill with modifier 26, but do we need to add a modifier 51 as well? Does Medicare consider 93640-93642 a separate procedure when done with an implant?

Illinois Subscriber

Answer: You won't need to append modifier 51 (Multiple procedures) on a Medicare claim when reporting 93640-93642 (Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator ...) for the simple reason that Medicare asks coders not to use modifier 51.

As NGS, the MAC for Illinois, explains, "Medicare does not recommend reporting modifier 51 on your claim submission. Our claims processing system has hard-coded logic to add the 51 modifier to the correct procedure code." (You can find the Modifier 51 article with this statement by opening the site for Illinois part B and searching for "modifier 51." Choose the "Modifier 51" link from the search results.)

Reminder: Use 93640 and 93641 for testing at time of initial implant. Code 93642 is for testing on a subsequent day.

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