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

[meadows]

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!

 

[csperoni]

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.

 

[meadows]

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