Wiki podiaty modifier

[denali]

I have a question - this is my new favorite place to be
My podiatrist billed
99203-25
73630
64450
j0704
29515 - which mod should this get 51 or 59?

It was denied because 64450 and 29515 should not be done on the same day, I have told her this, but she insists on billing and then having to appeal it, ususally losing the fight. But, I did bill the 29515 with a 51 - and she questioned that saying it should have been a 59.

If anyone can help me with the CCI edit table, I would be grateful, I cannot seem to locate it online, and I know that I need to find the mutually exclusive table for sure.


Thanks

 

[mbort]

here is the CMS link to the edits for you. Does the physicians documentation support the use of a -59 modifier??

http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp

 

[Lisa Bledsoe]

This isn't for morton's neuroma is it?

 

[denali]

So, I should have used 59 not 51 - in reality I think Medicare added that modifier itself - but I will look at that again -
and no it is not for morton's neuroma, why?

And as far as I know, she states that it does support the use of 59 modifier -
Thanks for all of the help

Is there a time that I would bill 51 mod myself?, is that in one of the edits? I am having extreme difficulty getting this all of a sudden, I have been doing this for years, and now it seems like I don't know anything. Very frustrating point right now, and I appreciate all of the assistance.

 

[mbort]

You will probably still need to use the modifier 51 for your commercial payors, but the -59 in the primary modifier field, again IF the documentation supports it. To be perfectly honest, I would not be taking the physicians word for it, I would want to see the documenation myself prior to applying a -59.

Hope this helps! Good Luck
Mary Bort, CPC