Modifier 51-Help -disputing

mcoria

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Help -disputing a provider payment-Billing 36247, 37204,75726 26 and 75984 26
Provider does not agree; 36247 requires a mod 51 and 75726 26 is included with 37204
Whos right???
 

donnajrichmond

True Blue
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518
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Alexandria, LA
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Help -disputing a provider payment-Billing 36247, 37204,75726 26 and 75984 26
Provider does not agree; 36247 requires a mod 51 and 75726 26 is included with 37204
Whos right???
Your payer is.

Technically, 36247 does need a 51 modifier since there are 2 surgical "procedures". Most payers don't require the 51, but some do.

75726-26 is included in 37204 unless it meets the guidelines for a separate diagnostic study as outlined in the CPT guidelines. If it meets those guidelines, then modifier -59 is required to indicate that it is a separate diagnostic angiogram.
 
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