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Correct modifier for medicare

  1. Default Correct modifier for medicare
    Medical Coding Books
    We are billing cpt 11301x3 and 11300x5, but list each on separate line. Looks kinda like this:
    11301 216.5 dx
    11301-76 216.5
    11301-76 216.5
    11300-59 216.6
    11300-76 216.6
    11300-76 216.6
    medicare doesn't want modifier 51 used by billers. We are having this discussion in our office on whether these modifiers should all be -59 or -76. Same body area, same patient, same doctor, but separate lesions and sizes. Someone even suggested using -59-76 together. What is correct for alabama medicare?????

  2. #2
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    Columbia, MO
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    12,531
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    just the 59 these are not repeated since each is a different lesion at a separate site. They are distinct and separate and that is the 59 modifier. A repeated procedure is exactly the same procedure repeated at a separate session. Separate lesions cannot be exactly the same and they are performed in the same session.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Thumbs up
    Quote Originally Posted by mitchellde View Post
    just the 59 these are not repeated since each is a different lesion at a separate site. They are distinct and separate and that is the 59 modifier. A repeated procedure is exactly the same procedure repeated at a separate session. Separate lesions cannot be exactly the same and they are performed in the same session.
    agreed :-)
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Location
    Lauderdale Lakes, FL
    Posts
    19
    Default tricky....
    Quote Originally Posted by SANDRA76 View Post
    We are billing cpt 11301x3 and 11300x5, but list each on separate line. Looks kinda like this:
    11301 216.5 dx
    11301-76 216.5
    11301-76 216.5
    11300-59 216.6
    11300-76 216.6
    11300-76 216.6
    medicare doesn't want modifier 51 used by billers. We are having this discussion in our office on whether these modifiers should all be -59 or -76. Same body area, same patient, same doctor, but separate lesions and sizes. Someone even suggested using -59-76 together. What is correct for alabama medicare?????


    I would not use the -76 as its not a repeated procedure (as others have accurately noted).

    However, if you bill 2 lines exactly the same, you will likely get denied for duplicate

    11301
    11301-59
    11301 - ??
    11300-59
    11300 - ??
    11300 - ??

    I have this dilemma in Florida, too. However, I have had some luck using -51:

    11301
    11301-59
    11301-51
    11300-59
    11301-51
    11301-51-59

    Anyone else have any thoughts?

  5. #5
    Location
    Columbia, MO
    Posts
    12,531
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    You should not have any issues with the 59 as it makes each line distinc and separate. I have never had an issue with it. Try
    11301
    11301 59 51
    11301 59 51
    11300 59 51
    11300 59 51
    11300 59 51
    There should not be an issue with duplicate as the modifier is suppose to be adudicated separate from the code. If you are having this problem then you need to appeal to the carrier.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default repeat procedure?
    please help...I need a answer,I am currently in disagreement over this. Say you are billing a xray 73110 (3view) doctor orders a post-reduction film after fx has been set xray 73100 (2view) although they are not same procedure (correct) please explain to me why my co-worker keeps insisting billing these codes with a modifier "76"and when insurance fails to pay..she wants me to appeal?please help any suggest would be helpful

  7. #7
    Location
    Columbia, MO
    Posts
    12,531
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    Quote Originally Posted by rbargar View Post
    please help...I need a answer,I am currently in disagreement over this. Say you are billing a xray 73110 (3view) doctor orders a post-reduction film after fx has been set xray 73100 (2view) although they are not same procedure (correct) please explain to me why my co-worker keeps insisting billing these codes with a modifier "76"and when insurance fails to pay..she wants me to appeal?please help any suggest would be helpful
    You cannot use the 76 as you have noted these are not the same service so you will have to use the 59. I do not understand why the doctor does not just repeat the 3 view. Your co worker is seeing this as a repeat service since they are doing another xray of the same area, however they have changed the procedure thereby making it not a repeated service.

    Debra A. Mitchell, MSPH, CPC-H

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