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Does this publication exist?

  1. #1
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    Everett, WA
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    Default Does this publication exist?
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    What entity publishes a list of insurance payers that require modifier 51 to be submitted/not submitted for multiple procedures ? Are there any? From what I've gathered there seems to be a general concensus NOT to use it. So, if you utilize it when it's NOT required will that generate a further reduction in revenue, or conversely, if you don't use it when it required will that render an improper payment? Take, for example....Aetna. Even after reading their policy on modifiers for multiple surgical procedures, still seems a little murky to me. ANY input is appreciated!
    ---Suzanne E. Byrum CPC

  2. #2
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    Tacoma, WA
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    Quote Originally Posted by ollielooya View Post
    What entity publishes a list of insurance payers that require modifier 51 to be submitted/not submitted for multiple procedures ? Are there any? From what I've gathered there seems to be a general concensus NOT to use it. So, if you utilize it when it's NOT required will that generate a further reduction in revenue, or conversely, if you don't use it when it required will that render an improper payment? Take, for example....Aetna. Even after reading their policy on modifiers for multiple surgical procedures, still seems a little murky to me. ANY input is appreciated!
    ---Suzanne E. Byrum CPC
    As far as I know, this type of resource book does not exist. The thing to know about modifier 51 is, you don't HAVE to use it. The insurances generally have an edit built into their claims processing that automatically does the reductions.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
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    Everett, WA
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    Arlene, thanks for responding as I was beginning to fear this question might be another one of mine that goes unanswered. The problem with not using 51 is that it is required with one of our carriers; otherwise certain line items will not get paid! Just thought it might be prudent to discover which carriers recognize it from the front end and not to have to work from the back end. Guess we'll just go ahead and submit without it and see what happens. Thanks for jumping in and lending your "neighborly" support ---Suzanne E. Byrum CPC

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