51/59 needed?


San Francisco
Best answers
New to coding on my own and need a little assist. I read through the forums and online resources and found contradicting advice so thought I would check with Ya'll...

Doctor did:
ACL repair 29888 + Lateral meniscus repair 29882
with an assistant surgeon
Rt Knee
UHC insurance

When I check the CCI edits I don't find anything so I would think I just report
29888-RT, 29882-RT and for the assistant 29888-80-RT, 29882-80-RT
however on other forum posts with these same codes I have seen arguements for using either a 51 or 59 with the second code .
My brain may be on the fritz this afternoon, but I just can't find a solid answer. Thanks in advance

I checked the codes and also did not find any edits. I did run into a few places stating 29882 "Assistant payment not allowed" including mod 80. However, UHC may have a different policy on that.

My opinion - the codes with the RT mods should be good to go and a 59 would not be necessary according to the edits so I'd leave it off and I'd also go ahead and bill 29882 with the 80, then see what happens. The worst that could happen is a denial that might bring up the 59 issue and/or the assist denial, which I'd appeal with documentation for medical necessity.

UHC is notorious for modifier problems and billing codes with modifiers that MIGHT be needed just to make them happy can turn into a big mess if an appeal comes around. Billing appropriately (eg, no 59 because there's no edit) would be the way to go, then attack UHC if denials come back to the contrary.