Results 1 to 9 of 9

Modifier 51-My physician assisted

  1. #1
    Default Modifier 51-My physician assisted
    Medical Coding Books
    My physician assisted on a surgery. The codes billed out by the primary surgeon include a modifier 51 on the PRIMARY procedure. I questioned their use of mod 51 as I believe it will reduce payment on the prime procedure or will be kicked out as unable to process. I was told that their certified coder says they need to use the mod 51 on the prime procedure for reporting purposes to Medicare. What am I missing here?? Isn't this completely wrong?
    Julie

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    I agree with you. 51 needs to be appended to the surgical procedure with the lower fee schedule amount.

  3. #3
    Default
    Thanks for confirming, Rebecca. It doesn't make sense to me that a certified coder would think that was correct coding. They don't seem inclined to change it, though. As an assist, do you think I should bill it correctly as I see it to be?
    Generally, we try to bill out exactly as the primary surgeon as far as order of dx codes, etc in order for our claim to match up with the primary surgeon.

    What would you do? I am coming across many issues (errors in coding) as the assist to this particular primary surgeon and we assist with him a lot. This includes incorrect CPT codes, dx codes, POS. Should I just code it correctly as I see it and then...
    how do I appeal on the other end if our claim is denied for not matching the prime surgeons?

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by Jarts View Post
    Thanks for confirming, Rebecca. It doesn't make sense to me that a certified coder would think that was correct coding. They don't seem inclined to change it, though. As an assist, do you think I should bill it correctly as I see it to be?
    Generally, we try to bill out exactly as the primary surgeon as far as order of dx codes, etc in order for our claim to match up with the primary surgeon.

    What would you do? I am coming across many issues (errors in coding) as the assist to this particular primary surgeon and we assist with him a lot. This includes incorrect CPT codes, dx codes, POS. Should I just code it correctly as I see it and then...
    how do I appeal on the other end if our claim is denied for not matching the prime surgeons?
    I would share your concerns with your manager. I would collect your proof and present this information to them. As an advocate for my providers, I try to ensure that their billing/coding is as accurate as possible. If I discover discrepensies/errors, they need to be addressed and corrected. Essentially, your providers are trusting you with this information. In light of RAC, no one can afford to become complacent. Since your surgeon assists the primary surgeon frequently, I'm sure they'll both appreciate your positive feedback. It's not an easy task but It's the most ethical/honest approach.

  5. #5
    Location
    Columbia, MO
    Posts
    12,526
    Default
    I agree with Rebecca, well said!

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default
    Quote Originally Posted by mitchellde View Post
    I agree with Rebecca, well said!
    Thanks for your replies ~ I have contacted the primary surgeon's office repeatedly and today's response was "BUT SOMETIMES IT'S A HIT AND MISS AS I'M SURE YOU KNOW." They don't seem overly concerned

  7. #7
    Default trvlingal1
    When billing surgery to Medicare Part B, the primary procedure is the procedure with the highest Fee Schedule amount - and does not require Modifier 51. However, even if you do not append Modifier 51 to the secondary surgery(s), Medicare's Claims Processing System will automatically append Modifier 51 to any surgical procedures it considers secondary. For an assistant surgeon, all that is required is the modifier that depicts the assistant (i.e., 80, 82, AS, etc.) and any informational modifiers (i.e., rt, lt, etc.)

  8. #8
    Default
    Right! I know we don't have to append mod 51 at all on any of the secondary procedures with medicare, but we def don't want to append it to the first procedure. I figure it "might" get processed correctly, BUT my feeling is they will either accept it and reduce the prime procedure payment or it will just get kicked out as an inappropriate modifier making it unable to be processed.
    This is simply one of the least of my problems with their coding...
    just frustrated.

  9. #9
    Location
    North Carolina
    Posts
    3,126
    Default
    I know it's frustrating. These type of "issues" do have a way of exposing themself. Whether it be from a reduction in revenue due to incorrect posting, high A/R due to incorrect coding or suddenly a request for medical notes due to inconsistent, dual physician reporting of charges. Keep paper trails of your recommendations and their responses.....

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 02:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 01:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 08:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 01:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 04:59 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.