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Thread: 51-vs 59 mod. And medicare

  1. #1
    Join Date
    Apr 2007
    Modesto California

    Angry 51-vs 59 mod. And medicare

    AAPC: Back to School
    I am going crazy. I'm in California and just recently Medicare has started to deny all procedures with a 51 modifier. Some of the girls are just resubmitting them with a 59 modifier. For example a pt presents with SOB, COUGH and CHEST PAIN. DX. ARE 465.9, 786.2, 786.05 AND 786.51. The CPT codes are billed originally as 99213-25 , 94060, 94640-51 and 93000-51.
    They pay the OV and 94060 and deny the 94640-51 and 93000-51 with denial code CO4 (The procedure code is inconsistent with the modifier used or a required modifier is missing.) Do I just bill the procedures with no modifiers?? This has never happenned before. PLease Help

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    Yes bill with no modifiers, they may have dropped the 51 out of their electronic edits

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Red face

    I agree with Debra,

    Medicare no longer requires 51 modifier. Be careful though, other carriers, such as Medicaid still want the 51. So you should only omit the 51 from Medicare claims and insurances that do not require it.

    Caprice Walder, CPC

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