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Wiki Modifier -51 on Diagnostic Procedures??

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ashleytenee@gmail.com

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There has recently been an argument in our department regarding missing modifier -51 on 92133. The claim was billed out with 92083 and 92133. I just want to make sure I am understanding. I cannot find anything that shows we should use this modifier on 92133 as it is more of a "surgical modifier". Can anyone help me understand or give me a solid answer.

Thank you in advance!
 
ashleytenee@gmail.com said:
There has recently been an argument in our department regarding missing modifier -51 on 92133. The claim was billed out with 92083 and 92133. I just want to make sure I am understanding. I cannot find anything that shows we should use this modifier on 92133 as it is more of a "surgical modifier". Can anyone help me understand or give me a solid answer.

Thank you in advance!
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While I don't know much about this topic, in your CPT book there is an Appendix E, which is a Summary of CPT codes Exempt from Modifier 51.
92133 is NOT on that list.
 
I know nothing of ophthalmology. Yes, per Codify -51 is a valid modifier for 92133. However, -51 (even when appropriate) is often recommended to NOT be used. I specifically know there are some MACs that give guidance to not use -51 on multiple procedures; it will be added by their claims software to the appropriate codes.
The reason for this guidance is that sometimes claims are submitted with -51 on an incorrect procedure. For example, an add on code, or the code that actually has the highest RVUs.

I have never seen a claim denied for missing -51. I have seen claims paid incorrectly due to -51 on the wrong procedure.
 
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csperoni said:
I know nothing of ophthalmology. Yes, per Codify -51 is a valid modifier for 92133. However, -51 (even when appropriate) is often recommended to NOT be used. I specifically know there are some MACs that give guidance to not use -51 on multiple procedures; it will be added by their claims software to the appropriate codes.
The reason for this guidance is that sometimes claims are submitted with -51 on an incorrect procedure. For example, and add on code, or the code that actually has the highest RVUs.

I have never seen a claim denied for missing -51. I have seen claims paid incorrectly due to -51 on the wrong procedure.
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yes.
After I posted my response, I dove down a little rabbit hole on modifier -51.

I agree with Christine's detailed response.
 
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