Wiki Denial Help!

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I'm new to opthamology coding, and we just got a denial on procedure code 68840 e4, 68440 e4, 51. After looking at the cci edits mod 51 isn't allowed which doesn't make any sense to me. Also we got a denial on 15823 e1, 15823 e3 , 50 .

Can anyone help me with these?:confused:
 
Denial help

Hi:

It appears that 15823 should have been billed as 1 unit with modifier 50 indicating a bilateral procedure.

On the other scenario, it appears that modifier 59 should have been used instead of modifier 51.

I am not an ophthalmology coder, but I do have experience coding other specialties which use modifier 51 and modifier 59.
 
That's what I thought too for the 15823, and on the other one mod 59 says to use only if its for a different anatomic site or separate encounter so we can't use that either. I just can't believe the mod 51 won't work, because it is multiple procedures. Thank you for your help! Have a Great Day! :)
 
68840 has an MUE of "1". It is not allowed per eyelid, but per eye. If it's done bilaterally it should be billed with modifier 50 and one unit (to Medicare). For other payers you would need to check their policies.
 
Right, so since both the 68840 and the 68440 were done on E4 its bundled and not payable? Do you know why Medicare doesn't allow Mod 51 for multiple procedures?
 
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