Lap tubal w/ Hysteroscopy D&C and endometrial ablation

[mllivers]

Hi,

So my question is if I am billing a 58671 and 58563, which do I need to add the 51 modifier to?

Thanks

 

[such78]

when 58563 is performed with another separately identifiable procedure, the highest dollar value code is listed as the primary procedure and subsequent procedures are appended with mod-51.

 

[csperoni]

I was told many many years ago at a Medicare seminar that there is no need for us to add -51. The claims processing systems will automatically pay the highest at full, then add -51 to secondary for 50% payment.
In fact, I have seen commercial insurance situations where someone used -51 on the wrong procedure and as a result, we were shortchanged payment. It's then a whole process to submit a corrected claim, appeal, etc.
I have not used -51 in at least 10 years.
For a reference, here is Novita's page about -51 where they state it is not recommended. https://www.novitas-solutions.com/w...ntentId=00144532&_adf.ctrl-state=86hvagjfk_33

 

[mllivers]

I was told many many years ago at a Medicare seminar that there is no need for us to add -51. The claims processing systems will automatically pay the highest at full, then add -51 to secondary for 50% payment.
In fact, I have seen commercial insurance situations where someone used -51 on the wrong procedure and as a result, we were shortchanged payment. It's then a whole process to submit a corrected claim, appeal, etc.
I have not used -51 in at least 10 years.
For a reference, here is Novita's page about -51 where they state it is not recommended. https://www.novitas-solutions.com/w...ntentId=00144532&_adf.ctrl-state=86hvagjfk_33

Interesting, thank you for that article!