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Modifiers -59 vs -50

  1. #1
    Location
    Iowa City, IA
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    18
    Question Modifiers -59 vs -50
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    When billing 21390 for both orbital floor blowout fractures, what modifier is appropriate?
    According to Medicare the -50 modifier is not valid.

  2. #2
    Location
    Duluth, Minnesota
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    21390 has a status indicator of "0" in the bilateral column. "0" means - bilateral surgery rules do not apply, do not use modifier 50.

    how about RT/LT?
    Donna, CPC, CPC-H

  3. #3
    Location
    Iowa City, IA
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    18
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    Quote Originally Posted by lindaskin View Post
    When billing 21390 for both orbital floor blowout fractures, what modifier is appropriate?
    According to Medicare the -50 modifier is not valid.
    Is 21390 considered a unilateral or bilateral procedure?
    We have tried using the LT & RT without success.

  4. #4
    Default
    Maybe try billing 2 units? I see Medicare allows 2 and so does UHC, so maybe others do too?

    http://www.cms.hhs.gov/apps/ama/lice..._MUE_Table.zip

    https://www.unitedhealthcareonline.c...List_09Q1A.htm
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  5. #5
    Location
    Iowa City, IA
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    Default
    Do you know anything about BCBS (IA)?

  6. #6
    Location
    Duluth, Minnesota
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    what's the exact denial reason they're giving you?
    Donna, CPC, CPC-H

  7. #7
    Location
    Iowa City, IA
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    too many services on the same day

  8. #8
    Location
    Duluth, Minnesota
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    hmm.. and that's the only code you're billing out?... is there a CCI Edit if you're coding out other codes with it?...
    Donna, CPC, CPC-H

  9. #9
    Location
    Iowa City, IA
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    no other codes billed with it

  10. #10
    Location
    Duluth, Minnesota
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    1,133
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    well, like bpct6501 said, you might try coding/billing it out with a x2 then, or the .51 or .59 modifier on the second one. (since you already did the RT/LT)

    hopefully someone else might have an idea on this... sorry can't be of more help.
    Donna, CPC, CPC-H

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