Wiki Modifier 51

[urbach34@yahoo.com]

Our office has received several denials from Medicare when billing multiple injections at the same time.

Example: M17.0, M75.42
20610- Rt (M17.0)
20610- Lt (M17.0)
20610- XS-Lt (M75.42)

First question, what do you think is incorrect about this?

Second question, one of our follow-up girls is adding modifier 51 to these and sending them back out the door without ever bringing back to our coders.
Example of how she is changing it: M17.0, M75.42
20610- Rt-51
20610- Lt-51
20610- XS-Lt

The other coder, in my office, and I have never used modifier 51 on injections before. Is this appropriate? We have made copies of the claims we have noticed her doing this to, and are waiting to see what Medicare does. Do you think this is going to pay?

 

[estebangarc78@gmail.com]

Mod 59

Hello I would resubmit the claim with Mod 59. The first line item does not require a modifier but the rest of line items do require mod 59. I am assuming the denial reason from Medicare is to append the appropriate modifier. I suggest you looking into the EOB.

Mod 59- Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries). From our CPT books.

Resubmit as shown below.

20610- Rt (M17.0)
20610-59- Lt (M17.0)
20610-59- XS-Lt (M75.42)

Thank you,

 

[MARY K]

Multiple injections

I currently work at a busy Orthopedic office. At our office when multiple injections are done for 3 separate large joints, we typically bill out like:
20610 50 m17.0
20610 59 LT m75.42

 

[urbach34@yahoo.com]

We do bill them that way sometimes, sometimes we split out the 50. We haven't had problems in the past either way. I'm wondering if these particular claims are denying for something else. I'm not sure why our follow-up girl sent them back out with a 51 modifier when neither of our coders told her to do that. Before I took them to our manager, I wanted to make sure we weren't missing something. Neither of us have ever used 51 on injections before. I'm not sure where she got this from!