Wiki Modifier 51-Help -disputing

[mcoria]

Help -disputing a provider payment-Billing 36247, 37204,75726 26 and 75984 26
Provider does not agree; 36247 requires a mod 51 and 75726 26 is included with 37204
Whos right???

 

[donnajrichmond]

Help -disputing a provider payment-Billing 36247, 37204,75726 26 and 75984 26
Provider does not agree; 36247 requires a mod 51 and 75726 26 is included with 37204
Whos right???

Your payer is.

Technically, 36247 does need a 51 modifier since there are 2 surgical "procedures". Most payers don't require the 51, but some do.

75726-26 is included in 37204 unless it meets the guidelines for a separate diagnostic study as outlined in the CPT guidelines. If it meets those guidelines, then modifier -59 is required to indicate that it is a separate diagnostic angiogram.

 

[mcoria]

Modifier 51

Thank you