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Modifier 51 and 50

  1. #1
    Location
    Salisbury, MD
    Posts
    27
    Default Modifier 51 and 50
    Exam Training Packages
    Okay, I am double checking myself here.

    Injection of paraverteberal facet joint at the cervical level with one additional level, bilaterally, would be as follows:

    64470-50
    64472-50

    Is this correct? We would not use modifer 51 here, right?

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    Correct...

    Example: C3-C4 C4-C5

    64470-50
    64472-50

    No modifier 51

    There may be some carriers that require the RT/LT modifiers...but mine prefer 50

  3. #3
    Location
    Salisbury, MD
    Posts
    27
    Default Just to be sure
    So, just be sure, you wouldn't bill
    64470-50
    64470

    64472-50
    64472

    I know as I am typing this it is wrong, but I have someone really questioning me, so I want to be sure!

    thanks

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    NO! You are correct.

    Codes 64470-64476 are unilateral procedures. When bilateral injections are performed then modifier 50 should be appended to the appropriate code. Also modifier 51 should not be appended to codes 64472 or 64476 because these are add-on codes and exempt from the multiple procedure concept.

    Medicare monitors these procedures closely...

    http://www.cms.hhs.gov/transmittals/...ds/R526OTN.pdf

    Also...don't forget your fluoro

  5. #5
    Location
    Salisbury, MD
    Posts
    27
    Default
    Thank you Rebecca! You have been a wealth of knowledge.

  6. Cool Office Visit with Injection & Adminstration of an Injection
    PPO insurance companies accept and pay for office visits, injections & adminsitration of injection charges only if a modifier 25 is placed on the office visit & a modifier 51 is placed on the adminstration charge.
    I realize the modifier 51 is for procedures but this is how they will process the claim.
    Does anyone know where I can find this accepted protocol in print to show the rest of my staff?

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