Chill74
Contributor
I work for an orthopedic surgeon , he billed a 28485 and 12041 , with modifier 59 attached to 12041 and it was denied (inappropriate modifier with procedure code), any thoughts on if it should have been modifier 51?
Agree, 51 modifier is rarely used at this point.Going along with Amy's comment...51 modifier is rarely added by the provider/coder. It is a modifier that the payer adds in their system. There are only a few plans, most are Medicaid, that want the coder/provider to add the 51 modifier. Amy is correct when she suggests that you may be unbundling the 2 codes. Take a look at the CCI edits for these 2 codes. If they were performed on the same site, they are bundled together and only the 28485 should have been coded.