Wiki Sinus surgery codes

[jdibble]

I could use some help in correct coding and sequencing for sinus surgery. Dr did the following procedures, but my question is would I need to use the 51 modifier? Or the 59 modifier? Also, according to our fee schedule the Septoplasty 30520 carries the higher fee, so would I sequence that first or would I bill a bilateral procedure first?

30520, 31276-50, 30140-50, 31255-50, 31267-50

Thanks for any help given.

Jodi Dibble, CPC

 

[kdm]

We always bill the septoplasty 30520 1st.
kdm

 

[jdibble]

What modifier?

Thanks kdm for your response! Could I also ask, would you also use a 51 or 59modifier with those charges?

Jodi, CPC

 

[hart65ley]

I do not bill the -51 or -59 modifier on them, but would like to hear what others are doing with these codes.

 

[azukixx]

I do not use -51 or -59 either when I bill these out, and they always get paid.

 

[marcos226]

30520, 31276

thus endoscopy already included in 30520? - I am in pre approval - and provider is requesting for 30520, 31276 as the procedure will be done thru endoscopy.

As my understanding endoscopy is already included under 30520. and 31276 is only billable if sinosutomy is done.

Kindly help.

 

[ljones88]

-59 mod isn't required on any of those codes as billed (assuming no other codes are going to be billed that would bundle another to the other). We bill this exact situation often and they get paid.

A -51 mod isn't required anymore for most payers. We are contracted with many payers and the ONLY payer at this time that requires a 51 on subsequent codes is Wellcare/Staywell.

Just FYI in case you do end up billing codes that are bundled and a modifier may be appended: The only reason one would apply the -59 modifier to unbundle a bundled code pair is if the service is truly separate and distinct from the other procedure that it is bundled to. I like to apply the new X(E,P,S,U) situation when thinking about the -59 modifier
-Was the procedure in question performed at a different encounter?
-Was the procedure in question performed by a different provider?
-Was the procedure in question performed on a totally different anatomic site (right only, vs left only for the other procedure, for example)?
- Was the procedure in question performed for a totally unusual overlapping reason that can be justified in the op note?
If the answer is no to those questions, the -59 modifier may not be supported.

If the bundled codes were done bilaterally, the -59 modifier (9x out of 10) is not going to be supported. The -59 shouldn't be applied to simply bypass edits.