Wiki 25295 - cpt

[agiannino]

I am having tons of issues getting this code to pay for multiple procedures. I have appended modifier 51 and 59 - still nothing. BCBS is saying they have a unit restriction but when going to appeal they say otherwise. I'm so confused.

Anyone else bill for the hands and have seen this code pay for multiple units??

 

[OCD_coder]

I found that BCBS has an MUE edit maximum of 9 units per DOS.

I bill them on one line with the qty/# reflecting how many tendons are lysed; I don't bill using mod-51 or 59 on separate lines unless both wrists/forearms have work performed at the same surgical session. I have never billed more than 3 units at a time and have no trouble with denials. Just as a general note, do not apply finger modifiers to this code as it they do not apply, only LT or RT. Not sure that is an issue for your situation or not.