modifier usage

bluemoon1

Networker
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52
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A flat polyp needs to be removed. The doctor does a submucosal injection and removes the px by snare. Is the correct code sequence 1) 45381, 2) 45385 - 59? I list 45381 first and 45385 second with modifier 59. We have been getting paid.
 

Anna Weaver

True Blue
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769
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Kokomo, IN
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It's not always a matter of getting paid. As long as the codes are valid the insurance will pay in whatever order you put them. you want to check your RVU's, if there is a significant difference in RVU's, you want your highest to go first. you get reimbursed 100% for your first, when you use the 59 modifier, your second is dropped in value (I can't remember what reimbursement is), but say 75%, then for your third procedure it's dropped again. On down the line. So, you want your highest RVU's first, down to the least for maximum reimbursement.
 
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