Wiki please help with a question

[suzannereed]

Please help me!

Here's the order of procedures done, according to the post operative report:

cystourethroscopy 52000
electromyogram of anal/urethral sphincter 51784
uroflow-complex 51741
cystometrogram - complex 51726
bladder voiding pressure 51795
rectal and/or intraabdominal voiding pressure 51797

How do I bill this? The insurance is Medicare and FL Medicaid.

Is the below correct? What about the modifers?

51726
51795-51
52000-51
51784-51
51797-51
51741-51

I feel like I might need a modifer 59 somewhere? Can anyone shed some light on this for me? I am still new to coding and only a CPC-A.

 

[craftqueen58]

I'm not sure about the order of billing for you but I did notice a couple of things to recheck. You have modifier -51 on 51797, however, that is an add on code which is exempt from that modifier so you don't need to put that there. Also, was everything for these procedures provided for by the physician (ie, equipment,catheters, supplies, technician fees) or is the physician only interpreting the results of these studies. If he is only interpreting you need to add modifier 26 for the professional component. I'll keep researching about the order. I know that I've always been told that you code the most involved (therefor the most expensive) procedure first and then continue on from most involved to least since you get reimbursed at a lower precentage for each additional procedure. Good luck!!

 

[suzannereed]

Thank you so very much. Shame on me for putting a 51 modifer on an add on code. Please do keep researching the order. Thanks again.

 

[Corkey453]

help

52000 is bundled and should not be billed
do not use -51 modifier with Medicare claims ( internal modifier)
always list largest RVU value first

59 is used to unbundle if considered bundled to another procedure.
Check NCCI and follow the guidelines if appropiate for unbundling.

Good luck