Modifier 51 and 50

[lbusby2]

Okay, I am double checking myself here.

Injection of paraverteberal facet joint at the cervical level with one additional level, bilaterally, would be as follows:

64470-50
64472-50

Is this correct? We would not use modifer 51 here, right?

 

[RebeccaWoodward*]

Correct...

Example: C3-C4 C4-C5

64470-50
64472-50

No modifier 51

There may be some carriers that require the RT/LT modifiers...but mine prefer 50

 

[lbusby2]

Just to be sure

So, just be sure, you wouldn't bill
64470-50
64470

64472-50
64472

I know as I am typing this it is wrong, but I have someone really questioning me, so I want to be sure!

thanks

 

[RebeccaWoodward*]

NO! You are correct.

Codes 64470-64476 are unilateral procedures. When bilateral injections are performed then modifier 50 should be appended to the appropriate code. Also modifier 51 should not be appended to codes 64472 or 64476 because these are add-on codes and exempt from the multiple procedure concept.

Medicare monitors these procedures closely...

http://www.cms.hhs.gov/transmittals/downloads/R526OTN.pdf

Also...don't forget your fluoro

 

[lbusby2]

Thank you Rebecca! You have been a wealth of knowledge.

 

[coder12]

Office Visit with Injection & Adminstration of an Injection

PPO insurance companies accept and pay for office visits, injections & adminsitration of injection charges only if a modifier 25 is placed on the office visit & a modifier 51 is placed on the adminstration charge.
I realize the modifier 51 is for procedures but this is how they will process the claim.
Does anyone know where I can find this accepted protocol in print to show the rest of my staff?