Does 51102 Require a Laterality Modifier? Find out
Question: We have a claim that was returned with a code denial. Originally, we submitted 51102 and 99223-25 for a bladder aspiration in the emergency department (ED). The payer denied reimbursement for 51102 and stated the modifier was missing. We had a discussion with the urologist and reviewed the allowed modifiers on Codify, ultimately appending modifier RT to 51102. Code 51102-RT was denied again, and the payer indicated the procedure is inconsistent with the modifier. The physician was called to the ED to see the patient. The other code, 99223-25, was paid. How should we correct this claim? Arizona Subscriber Answer: Going off the information you provided, perhaps there might be a misunderstanding regarding the use of modifier RT (Right side). You’ll use this modifier to indicate the procedure was performed on the right side of the patient’s body. However, code 51102 (Aspiration of bladder; with insertion of suprapubic catheter) isn’t specific to one side of the body. This may be why 51102 was denied due to being inconsistent with the modifier. Instead of appending a laterality modifier to 51102, you could consider using modifier ET (Emergency services), as the urologist performed the bladder aspiration procedure in the ED. You mentioned the physician was called to the ED to treat the patient and that reimbursement for 99223 (Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.) with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) was already approved. Another option is to thoroughly review the medical documentation and query the provider again in case 51102 is not the correct code for the procedure that was performed. And, of course, you can always contact the payer to understand why 51102 was denied and to confirm which modifier is needed to approve the claim. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
