Wiki Urgent: Modifier Issues Outpatient Hospital & ASC Surgery

[jsd123]

Help! I have gotten myself so confused! Can you only use the (abbreviated/shorter) list of modifiers at front of CPT book for outpatient surgery at hospitals & ASC's?

If so, what do you do about multiple procedures? (e.g. "51" isn't available!)

Also out of curiosity--I assume there are no modifiers for facilities? (e.g. for inpatient surgery its just a facility fee for the ICD-9 procedure code?)

Thanks!
Janice

 

[mitchellde]

51 is not a facility modifier that is correct, there is not modifier for multiple procedures in the facility you do not need one, there are no modifiers for the ICD-9 volume 3 codes.

 

[jsd123]

TY & Follow-Up

Thanks Debra! One more related question--as I'm easily confused! ;-)

I assume for the professional billing by the surgeon, that the 51 modifier is used when he/she bills the CPT for the professional billing?

TY again!

janice

 

[capricew]

I bill for an asc,
medicare no longer requires the 51 modifier as they will automatically reduce each additional line item by 50%

there are some carriers however, that still want the 51 modifier regardless of the medicare rule. Your contract should state this if this is the case.

Also, if you bill for a facility on a hcfa 1500, some carriers are still requiring the sg modifier, whereas medicare has done away with it. Again this sg requirement should be in your individual contract with carriers.
The sg was once developed so that when medicare received a hcfa the sg designated the claim from that of an office billing for a physician but block 24 b, place of service, has taken care of that issue.

Caprice, cpc