Modifier 51 help!!!!!!!

[mattrobin]

I need some help understanding when you can and can not use modifier 51?
I have a doc who performed two injections, same pt, same day- different site... Can i report modifier 51?
Thanks!

 

[kumeena]

need little more information . what type of inections? Mod 51 is for multiple procedures.

 

[Mjones7]

Be sure to double check your code(s) are not modifier -51 exempt.

 

[mitchellde]

I need some help understanding when you can and can not use modifier 51?
I have a doc who performed two injections, same pt, same day- different site... Can i report modifier 51?
Thanks!

It does help to know the codes you are using such as a joint inject say right shoulder rt hip would be
20610 rt
20610 59 rt 51
a therapeutic injection would be
96372
96372 59 51

 

[Lisa Bledsoe]

If you are coding for bilateral injections to Medicare (ie both knees) you would code 20610-50 and increase the fee by 50%. If separate joints (knee, hip) 20610 w/dx for one joint and 20610-59 w/dx for the other joint.

 

[Jamesmmm]

modifier 51 means you do not expect to collect 100% of the normal amount from the carrier. Bit if the carrier thinks that the multiple procedure(s) reduced the value of the services, that is when they will apply the reduction, and even if you do not apply the modifier, they will append it and they will pay 50% of their normal amount. In the case of the injections, normally the doctor's work effort was not reduced, so it probably would not apply. Bill the codes without the modifier, and if the carrier reduces the payment, write an appeal stating that the doctors' effort was not reduced and the reduction was unfair. (Before writing the appeal, make sure the doctor approves it!)
jm

 

[Walker22]

modifier 51 means you do not expect to collect 100% of the normal amount from the carrier. Bit if the carrier thinks that the multiple procedure(s) reduced the value of the services, that is when they will apply the reduction, and even if you do not apply the modifier, they will append it and they will pay 50% of their normal amount. In the case of the injections, normally the doctor's work effort was not reduced, so it probably would not apply. Bill the codes without the modifier, and if the carrier reduces the payment, write an appeal stating that the doctors' effort was not reduced and the reduction was unfair. (Before writing the appeal, make sure the doctor approves it!)
jm

I'm sorry but I must disagree with this. Any time a physician performs two procedures on the same patient at the same time, the one with the lower RVU value should have a mod-51. The physician's workload is always reduced for the second procedure done during the same visit.

 

[mitchellde]

Walker is correct. The first procedure is paid at 100% because you had to perform all the prep the second procedure is reduced because they carve out the prep as it was already done. There is no way to appeal this. If your documentatation supports two different sessions on the same day for medical necessity then a modifier will allow the second procedure to not reduce.

 

[dballard2004]

On the 2010 National Physician Fee Schedule Relative Value File from CMS, when you locate the procedure and you scroll over to the column that says "Multiple Procedure" and there is the number 2 there, does that mean that -51 applies or not? I'm a little confused here because reading the manual seems to imply that the number 2 means that you can apply -51, but some of the procedures have a number 2 in that column and it does not make sense that -51 would apply (i.e. 69210 for cerumen removal).

 

[Walker22]

A number "2" in the multiple procedure column in the RBRVS means that the mod-51 rules apply.

 

[dballard2004]

Thanks so much for clarifying.

 

[sammie06]

Modifier 50 or 51

Ok if I am billing a bilateral joint injections(20610), and they are being billed as two line items with a 50 modifier on one of them. Is this not the correct way to bill them, because Medicare denies the one with the modifier stating. Missing/incomplete/invalid days or units of service. What would you suggest. Thanks

 

[Walker22]

That is not the correct way to bill them. Bilateral joint injections would be billed like this:

20610-50

or

20610-RT
20610-LT,59

 

[sammie06]

20610-50

Thanks for the information. Do you know which one would work better when billing Medicare?

 

[Walker22]

I would use 20610-50 unless your carrier specifically tells you do it another way.

 

[sammie06]

Thanks again you have been very helpful.

 

[Walker22]

You're welcome!

 

[rbn_hampton@yahoo.com]

modifier 51

the doc did four level cerival facet blocks. workermen cpt codes 64440 and 64441.. do I use 64441 twice with a 51 on each level..expla: 64440(c2-3), 64441(c4-5), 64441-51(c5-6),64441-51(c6-7) 76003.. is this correct? thanks