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Modifier 77 And 51?

  1. Default Modifier 77 And 51?
    Medical Coding Books
    Help! I am sooo confused

    I spoke to Jason & Dorothy at Medicare today I have been advised by both do not use modifier 51 at all. I also asked if two hosp or office E/M codes are charged the same day by same provider they said use 76 and if the 2 E/M codes are charged by 2 different providers same day use 77. It doesn't matter if the e/m codes don't match exactly.

    I have multiple providers:
    Dr. A is at the hospital from 6:00 A.M. to 6:00 P.M and he see's Mrs. Smith for a 3/15/2008 99233 at 10:00 A.M.
    Dr. B is at the hospital from 7:00 P.M. to Midnight, and he see's Mrs. Smith for a 3/15/2008 99233 at 8:00 P.M.
    What would be the appropriate modifier to bill for both the 99233, same day, different providers.

    Also, Modifier 51 is still valid / active correct? The medicare rep said to stop using it.
    My doctors will do multiple procedures in the hospital.
    Example: Same day all three procedures, is 51 correct?


    Greatly appreciate any help

  2. #2
    North Carolina
    Our local region also stated this. They have indicated that they have edits in place to apply modifier 51 when applicable. Although they don't go into great detail, review page 17.
    Rebecca CPC, CPMA, CEMC

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  3. #3
    Louisville, KY
    If your providers are in the same group, same specialty, how can you go about charging/coding for two E/M same DOS?

  4. #4
    The modifier 51 is not incorrect nor invalid, the reason Medicare is telling you to stop using this modifier is because they will automatically apply it to multiple procedures. I use modifier 59 instead when the CCI edits allows unbundling the procedure.

    Hope this helps!!!

  5. #5
    Nashville, Tennessee
    I really enjoy this site. I did not realize that about Medicare and I usually stay pretty up to date with them. That is really crazy that they will determine when to apply the modifier 51. I think the rules change every day.
    I am curious as to how you can charge for two e/m's on the same day with two docs who practice within the same office unless they are under different tax id numbers...maybe?? Not sure. But thanks for the heads up on the modifier.

  6. Default
    I agree with Kevin. Also, Medicare will only pay for one visit per speciality per day. And it is usually whoever gets there claim there first. Everything I have read tells me one visit per day. Modifier 77 is for procedures, not E/M codes.

    Quote Originally Posted by kevbshields View Post
    If your providers are in the same group, same specialty, how can you go about charging/coding for two E/M same DOS?

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