Wiki spinal neurostimulator coding/billing

[alysn1drlnd]

I have a client that has coded/billed 63650, 63650-59, C1897, C1897...

They have also submitted w/o the -59 on another account. One account is paid more than the other, my question is: Is it appropriate to use the -59 in this scenario? It is not a NCCI edit so not sure the modifier is necessary, however with modifier reimbursement is more...don't want to break any rules...any help is appreciated. Thanks

 

[TriciaGahagan]

Modifier -59 Billing Guidelines

Reimbursement without the -59 modifier was less because the insurance carrier applied the multiple procedure discount (50%) for the 2nd CPT code. Carriers vary as to how they process claims with the -59 or -51 modifier. Multiple procedure guidelines usually pay 100% of the allowed amount for the 1st procedure and 50% of the allowed amount for the 2nd and subsequent procedures. Add-on codes are exempt from this rule and depending on the payor -59 modifier is also exempt. Which would be why your claim with the -59 modifier was paid more.

 

[alysn1drlnd]

Thanks! That's what I was thinking, but I just wanted to be sure because that code is not subject to multiple discounting (or so it says lol). Thanks again!