Wiki 51703 w/ 53660 Medicare help

[bill2doc]

Hi All,

I've billed out 51703 w/ 53660-51. Medicare is dening the claim stating that I need two modifiers. -51 is correct but they tell me I need another mod to seperate the reimbursement...???? Can you help. I'm billing for POS 21 professional services.

Thank you
Lynn

 

[btadlock1]

Hi All,

I've billed out 51703 w/ 53660-51. Medicare is dening the claim stating that I need two modifiers. -51 is correct but they tell me I need another mod to seperate the reimbursement...???? Can you help. I'm billing for POS 21 professional services.

Thank you
Lynn

It's an NCCI edit - 51703 bundles into 53660, but they have a status "1", which means the edit can be overridden. If records support billing both, add a 59 modifier to 51703, and they should process.

 

[bill2doc]

Do you suggest both modifier -51 and -59 ?

 

[btadlock1]

Do you suggest both modifier -51 and -59 ?

I think the 51 is probably unnecessary, if those were the only two procedures done. The fact that there were multiple procedures done, is kind of inherent, since you need to designate one as a 'separate procedure', anyways. I could be wrong, but I think that the 51 modifier is a little redundant, when you're already using the 59. Hope that helps!