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podiaty modifier

  1. #1
    Default podiaty modifier
    Medical Coding Books
    I have a question - this is my new favorite place to be
    My podiatrist billed
    99203-25
    73630
    64450
    j0704
    29515 - which mod should this get 51 or 59?

    It was denied because 64450 and 29515 should not be done on the same day, I have told her this, but she insists on billing and then having to appeal it, ususally losing the fight. But, I did bill the 29515 with a 51 - and she questioned that saying it should have been a 59.

    If anyone can help me with the CCI edit table, I would be grateful, I cannot seem to locate it online, and I know that I need to find the mutually exclusive table for sure.


    Thanks

  2. #2
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    here is the CMS link to the edits for you. Does the physicians documentation support the use of a -59 modifier??

    http://www.cms.hhs.gov/NationalCorre...CCIEP/list.asp

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    This isn't for morton's neuroma is it?

  4. #4
    Default
    So, I should have used 59 not 51 - in reality I think Medicare added that modifier itself - but I will look at that again -
    and no it is not for morton's neuroma, why?

    And as far as I know, she states that it does support the use of 59 modifier -
    Thanks for all of the help

    Is there a time that I would bill 51 mod myself?, is that in one of the edits? I am having extreme difficulty getting this all of a sudden, I have been doing this for years, and now it seems like I don't know anything. Very frustrating point right now, and I appreciate all of the assistance.

  5. #5
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    You will probably still need to use the modifier 51 for your commercial payors, but the -59 in the primary modifier field, again IF the documentation supports it. To be perfectly honest, I would not be taking the physicians word for it, I would want to see the documenation myself prior to applying a -59.

    Hope this helps! Good Luck
    Mary Bort, CPC

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