Question Mod 51 vs 59

[emmaginsberg]

Hey everyone, I’m pretty stuck with these two modifiers and how to use them. I work at a ASC. And I have two patients with denied claims for lipoma removals.

First patient had 11 total removed.
24075 right upper arm x5 (D17.21 ICD)
24075 left upper arm x2 (D17.22 ICD)
25075 right forearm/wrist x2 (D17.21 ICD)
25075 left forearm/wrist x1 (D17.22 ICD)
25071 left forearm/wrist x1 (D17.22 ICD)

Second patient had 10 removed
25075 right forearm/wrist x7 (D17.21)
25075 left forearm/wrist x3 (D17.22)

All separate incisions are noted in op note.

We used modifier 59 then I tried mod 51 when the procedure went to a different side with 59 on the multiples of the same area. I hope that makes sense.
I’m at a loss how to get these corrected.
Thank you in advance

 

[bhardwajv]

Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session. It applies to:
Different procedures performed at the same session
A single procedure performed multiple times at different sites
A single procedure performed multiple times at the same sites
No, modifier 59 should not be used if the same CPT is performed on different lateralities. Instead, modifiers RT and LT should be used to indicate left or right.

First Patient
24075-RTx5
24075-51,LTx2
25071-51,LT
25075-59,51,RTx2
25075-59,51,LTx1

Second Patient
25075-RTx6 (Max Mue per day is 6 only)
25075-51,RTx1
25075-51,LTx3

 

[CBLENNIE]

Hey everyone, I’m pretty stuck with these two modifiers and how to use them. I work at a ASC. And I have two patients with denied claims for lipoma removals.

First patient had 11 total removed.
24075 right upper arm x5 (D17.21 ICD)
24075 left upper arm x2 (D17.22 ICD)
25075 right forearm/wrist x2 (D17.21 ICD)
25075 left forearm/wrist x1 (D17.22 ICD)
25071 left forearm/wrist x1 (D17.22 ICD)

Second patient had 10 removed
25075 right forearm/wrist x7 (D17.21)
25075 left forearm/wrist x3 (D17.22)

All separate incisions are noted in op note.

We used modifier 59 then I tried mod 51 when the procedure went to a different side with 59 on the multiples of the same area. I hope that makes sense.
I’m at a loss how to get these corrected.
Thank you in advance

For CPT 24075 the MUEs for an OP facility, which includes an ASC, is 5 units per DOS, 25075 is 6 units per DOS and 25071 is 3 per DOS, regardless of anatomical site.
So, on patient 1, I would expect you would have 2 units of 24075 denied as in excess of the MUEs for the DOS. On patient 2, I would expect 4 units of 25075 to be denied as in excess of the MUEs for the DOS.

What was the denial reason code on your remits for these 2 patients? Who was the payer, Medicare, Medicaid, commercial insurance? It is hard to help with determine what your coding should be without know what the denial reason is.