Neurosurgery Coding Alert

Question: We have multiple claims coming back from Medicare-Palmetto GBA with modifier 51 added to the primary procedure instead as the secondary as we submitted (e.g., 22612, 63047-51; submitted: Medicare 22612-51; 63047). The Medicare rep's explanation is "From 2012, you do not submit codes with modifier 51, We would apply to the code which is going to be with multiple procedure discount." This reduces the payment by at least $500.00. How do we deal with this situation? Arizona SubscriberAnswer: Modifier 51 has been a no-no for several years now.  It is true that Medicare carriers apply the modifier 51 to the "appropriate" secondary code, which may or may not agree with your "secondary" code. Medicare has typically applied the reduction to the lesser valued code in their fee schedule to all codes which are subject to the multiple procedure rule. In the coding combination provided, 22612 (Arthrodesis, posterior or posterolateral technique, [...]