Wiki mod 51 and 59

[N70QW]

I am getting denials for surgeries, mostly colonoscopies where I have used the base procedure ie: 45384 with no modifier then 45385 with modifier 59, but the commercial carriers are denying them stating "multiple surgical procedures with same date of service must be billed with modfier 51"
It is my understanding if we use a 59 we do not need the 51 modifier along with it. Is that incorrect?

 

[scorrado]

You should be putting the 59 modifier on 45384 not 45385. 45385 has more rvu's so there should be no modifier on that code. Modifier 51 does not come in to play here. Hope this helps!

 

[N70QW]

Yes that does help, thanks. Sometimes I just don't understand why all the commercial, or government for that matter, can't play by the same rules. But you answered my question, thanks.

 

[N70QW]

Can someone help me with this scenario.
Claim for 49560 Repair initial incisional hernia, reducible
49561 Repair initial incisional hernia incarceated (different than first hernia)
49505 Repair initial inguinal hernia

Where would I put the modifiers? Shouldn't I be able to get reimbursed for all procures with the correct modifiers?

 

[m.j.kummer]

Can someone help me with this scenario.
Claim for 49560 Repair initial incisional hernia, reducible
49561 Repair initial incisional hernia incarceated (different than first hernia)
49505 Repair initial inguinal hernia

Where would I put the modifiers? Shouldn't I be able to get reimbursed for all procures with the correct modifiers?

According to CCI edits you do not need a modifier on any of these. The applicable diagnosis should be associated to the CPT code that it supports and that should take care of it. Emphasis on should.

 

[N70QW]

Thanks, I can't get Blue Cross to pay for it without modifiers and I tried no modifiers then used 59 but still they say they want modifiers but of course they "can't tell me how to bill"
thanks again

 

[m.j.kummer]

Thanks, I can't get Blue Cross to pay for it without modifiers and I tried no modifiers then used 59 but still they say they want modifiers but of course they "can't tell me how to bill"
thanks again

Ahhhh ...the bad new blues. There are so many things I want to say.

 

[Gloriaponti1]

I'm having the same issue with Blue Shield. I billed 49561, 49560-51, +49568 and they are refusing to pay for the 49560-51 stating that their software states they are bundled. I am going to send in a second level appeal with proof that they are not bundled. It's so frustrating. I may have to eventually send in the claim with the 49560, 59, 51. Has anyone had success with this? Thank you!

 

[mk2001]

Can someone help me with this scenario.
Claim for 49560 Repair initial incisional hernia, reducible
49561 Repair initial incisional hernia incarceated (different than first hernia)
49505 Repair initial inguinal hernia

Where would I put the modifiers? Shouldn't I be able to get reimbursed for all procures with the correct modifiers?

I show BCBS won't allow 49560 at all when billed with 49561.