Wiki ASC billing Colonoscopy and EGD the same DOS for Medicaid Entities.......... Modifiers? Please help. Thanks in advance

[jessirussell2003]

I was instructed last year dt multiple denials from Medicaid and Medicaid entities when billing a colonoscopy and an EGD the same DOS for our Ambulatory Surgical Center to add a 51 modifier to the EGD and we should be good. HOWEVER, I am wondering since all of the claims with the 51 mod for the ASC still are all in denial status. So I am wondering if that guidance I was given last year was for the professional side of tables. Please help with any guidance you have on this. Please and thank you so much.

 

[neecyangel@gmail.com]

Yes, Medicaid and Medicaid HMO's updated their system AGAIN, and if they are Primary you will be required to use 51 mod on codes that are additional procedures (not add on codes listed in CPT). Keep in mind they are still having system issues with their claims cross claims. So for now, medicaid secondary is requiring us to apply 51 mod after the primary insurance pays. It's a nightmare, but they are slowly paying. We have not been given an ETA for this fix.

 

[jessirussell2003]

Yes, Medicaid and Medicaid HMO's updated their system AGAIN, and if they are Primary you will be required to use 51 mod on codes that are additional procedures (not add on codes listed in CPT). Keep in mind they are still having system issues with their claims cross claims. So for now, medicaid secondary is requiring us to apply 51 mod after the primary insurance pays. It's a nightmare, but they are slowly paying. We have not been given an ETA for this fix.

I still have not gotten any of the lines with the 51 modifier on it to pay at all. I'm wondering if there is anything else to do for this issue. Wondering if there is anything we can print out and send to the ins to understand the whole51 mod and get this stuff paid. I was also wondering if it should be a different modifier on the ASC verse the professional side of this billing. Are you also in ASC? Thanks in advance for your help. Jessica

 

[CRmiller]

If you are speaking of Medicaid products only? Pennsylvania medicaid only reimburses ASC's for one procedure per date of service. You may want to check if that is the same for your state. For colon/EGD on same date of service the 51 modifier is appropriate for an ASC.

 

[jessirussell2003]

If you are speaking of Medicaid products only? Pennsylvania medicaid only reimburses ASC's for one procedure per date of service. You may want to check if that is the same for your state. For colon/EGD on same date of service the 51 modifier is appropriate for an ASC.

Thanks so much for your info. I have not heard that for the state of OHIO until lately but I am trying to get concrete evidence on this. Yeah it confuses me since I was instructed to add he 51 mod on the EGD for Medicaid entities. But those are still not getting paid. What am I doing wrong?