Question Is there a look up tool for modifier compatibility with CPT codes?


Piffard, NY
Best answers
Hi, there,
Is there a look-up tool for determining compatibility of modifiers with CPT codes? I am thinking of something like the CMS PFS tool or the one for NCCI edits. I know there is the
Modifier 51 exempt code list. For example, I was told that 59510 doesn't allow modifier 80, but could not find a resource to check that information. Suggestions will be received gratefully. Thank you!
If you have an online encoder, that should provide the info. Some CPT books (not the AMA one) will also give valid modifiers. The Medicare Physician Fee Schedule database has a column for indicator whether assistant is allowed, is not allowed, or is allowed under certain circumstances. With online tools, I can't recall the last time I used a manual Medicare listing for NCCI or MPFS.
Specifically, regarding 59510, -80 is definitely not allowed. Deliveries are the only scenario I am aware of where the assistant surgeon bills something other than the primary surgeon billed. For deliveries, the primary ob/gyn bills the global maternity code (assuming global maternity being provided). The assistant bills for the delivery only code with -80.
In your example:
Primary Dr. A 59510
Assistant Dr B 59514-80
There are some carriers that will only pay for C-Section assistant in high risk situations. You may want to check your carrier policy regarding this.
Hi Christine,Thanks very much for getting back to me. I appreciate your taking the time to share your expertise which is so valuable! Patty