Wiki Gyn modifier help needed

[DEBI MCLAUGHLIN]

Hi! I need some help with this. 56501 destruction of external female genital growths with modifier 59. 58300 placement of IUD with modifier 51. 58301 removal of IUD with no modifier. 56501 and 58300 both paid, 58301 denied as required modifier missing. Should I have also added a modifier to this line and if so, which one? Thanks so much!

 

[csperoni]

In this scenario, I would bill as:
56501
58301-51
58300-51

You should list the CPT with the highest RVU first with no modifier. Per CCI edits, there is no bundling of these codes. If there was (or the carrier policy indicates), then -59 would be appropriate.

 

[DEBI MCLAUGHLIN]

Thank you!

 

[katiya701]

Clarification on .51 modifier for iud removal and insertion

So if I bill 58300 and 58301 I have to add .51 modifier to one of those codes?

 

[AprilSueMadison]

So if I bill 58300 and 58301 I have to add .51 modifier to one of those codes?

Some payers do require it. There is no CCI edit as stated above, however it would serve your practice well to ensure you are following payer guidelines. If the payer cannot provide you information regarding the use of modifier 51, it may be something you can determine on your own by pulling a report from your practice management system if you have that capability. As in, review payments and denials when the modifier is used vs not used and then you can narrow down which payer does which.