Wiki Help with modifier

[KaylaRieken]

Patient is in the post op period from having a TURP done. The pathology showed prostate cancer. The patient then continued to have Space OAR and IMRT placement. I billed 55874.78 and 55876.78/51. Medicare paid the 55874 but is denying the 55876 because the procedure code is inconsistent with the modifer used or a required modifier is missing. Do I not need a 51?

 

[tori.a]

Medicare doesn't really like modifier 51. I would have just used modifier 78 on both 55874 and 55876. That could be why they are denying.

 

[KaylaRieken]

Thanks. I will give that a try.

 

[KaylaRieken]

We sent the claim back in with a 78 on 55876. They are still denying us saying that the procedure code is inconsistent with the modifier used or a required modifier is missing. Any other suggestions?