My provider is billing for 96130,96131,96136,96137. My computer system is editing stating code 96136 needs modifier 51. Should I add modifier 51 to code 96136?
Click here for more sample CPC practice exam questions with Full Rationale Answers
Laureen shows you her proprietary “Bubbling and Highlighting Technique”
Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page
Tag Archives: Modifer
Modifer 59 usage
Can someone explain to me the logic of adding A 59 MOD TO THE RADIOLOGY CODES HERE IS THE BREAKDOWN?
72170 59LT
73501 59LT
BOTH HAVE THE SAME DX, I AM CONFUSED BECAUSE THE 72170 DENIED AS INAPPROPRIATE MOD, AND INCLUSIVE.
72170 59LT
73501 59LT
BOTH HAVE THE SAME DX, I AM CONFUSED BECAUSE THE 72170 DENIED AS INAPPROPRIATE MOD, AND INCLUSIVE.
modifer 51 and 59 help
Can someone please advise me on modifer 51 and 59 for billing for colonoscopy and egd on same day or two different colon techniques used. For example 45385 and 45380, would you put at 59 on the 45380? What if colon and egd, 51 on the egd? I am being told conflicting things and it keeps changing. I bill the doctor portion and the ASC side as well. Thank you
modifer 25 or 57
Would I add a modifier 57 or 25 to an E/M if an individual has a laceration repair? Provider evaluates the cut, discusses risks and benefits and consent obtained for a laceration repair.
Anatomical Modifer for CPT 93459-26
Hello,
Texan Plus is denying CPT 93459-26 for lack of anatomical modifier. They are citing Pub. 100-20
Transmittal: 1136, Date: November 1, 2012, Change Request: 8111 as the policy from CMS they are following.
B. Policy:
Each NCCI edit has a modifier indicator of 0, 1, or 9.A modifier indicator of 0 indicates that an edit should never be bypassed even if an NCCI-associated modifier is utilized on the claim.That is, the column two code of the edit must be denied.A modifier indicator of 1 indicates that an edit may be bypassed if an appropriate NCCI-associated modifier is appended to the column one and/or column two code on an NCCI edit.That is, the column two code of the edit may be paid if an NCCI-associated modifier is appended to an appropriate code of the edit pair.A modifier indicator of 9 is assigned as a placeholder for edits that have been deleted.
The current NCCI-associated modifiers are: E1, E2, E3, E4, FA, F1, F2, F3, F4, F5, F6, F7, F8, F9, LC, LD, RC, LT, RT, TA, T1, T2, T3, T4, T5, T6, T7, T8, T9, 25, 27, 58, 59, 78, 79, and 91.
Additional modifiers shall be added to the above list of NCCI-associated modifiers that will allow an edit with modifier indicator of 1 to be bypassed when the modifier is utilized correctly. These modifiers are LM (left main coronary artery), RI (ramus intermedius coronary artery), 24 (unrelated evaluation and management service by the same physician during a postoperative period), and 57 (decision for surgery). Refer to Attachment A (Medicare Claims Processing Manual, Pub. 100.04, Chapter 23, Section 20.9.1 and 20.9.1.1) will be updated in the near future to include these new NCCI asociated modifiers.
These denials just started within the past two weeks.
Has anyone else encountered this issue?
Thank you,
Pam
Splint Application – does it need Rt or LT modifer
I do the professional coding for an ER. So if a patient comes in with an injury and the physician applies a splint/cast would we add the modifiers RT or LT to those codes. For example 29105/RT. Or for the professional fee should be not add the anatomical modifiers?
Thank you
Thank you
Best modifer to use when Spirometry or EKG’s are done during an office visit
Admittedly I struggle with when to use modifer 25 verses 59
If a patient has COPD and the provider is looking to assess lung function during a routine follow up appointment
Or
If a patient c/o chest pain duuring a follow up appointment for his diabetes and HTN and the provider orders an ekg
If in both scenerios the providers staff performs the procedures the results are interpreted by the ordering provider and documentation supports same
I beleive a modifer 59 would be most appropriate ,however not completely sure.
I maybe overthinking this but is the use of either modifier determined by reason for the diagnostics whether it be done as an annual assessment(but not duing an annual exam) on the same day to save the patient another seperate visit or diagmostic to rule out a condition or a concern
If anyone can help clear the air I would appreciate your help I have researched abd looked at several examples but still find this confusing
Thank you
Cheri
If a patient has COPD and the provider is looking to assess lung function during a routine follow up appointment
Or
If a patient c/o chest pain duuring a follow up appointment for his diabetes and HTN and the provider orders an ekg
If in both scenerios the providers staff performs the procedures the results are interpreted by the ordering provider and documentation supports same
I beleive a modifer 59 would be most appropriate ,however not completely sure.
I maybe overthinking this but is the use of either modifier determined by reason for the diagnostics whether it be done as an annual assessment(but not duing an annual exam) on the same day to save the patient another seperate visit or diagmostic to rule out a condition or a concern
If anyone can help clear the air I would appreciate your help I have researched abd looked at several examples but still find this confusing
Thank you
Cheri
20926 billed with RT/LT modifer Insurance denied can I bill with 50
We billed 20926 on two lines with RT/LT modifiers and the Insurance denied for the use of modifiers. This particular Ins in our state does not like those mod’s as well as the XS. Should I bill 20926 on ONE line with the 50 mod OR should I bill TWO lines with the 50 mod on the 2nd line? This is where I’m confused. I found this on a WPS site
Appropriate Usage of 50 mod
"Submit codes with a BILAT SURG on one line appending either modifier 50 using one unit of service (UOS);
AND
Inappropriate Usage
"Do not use modifier 50 for multiple procedures on one organ, such as the skin."
"Do not report a bilateral procedure on two lines of service appending modifier 50 to the second line of service"
Can someone please help me?
Appropriate Usage of 50 mod
"Submit codes with a BILAT SURG on one line appending either modifier 50 using one unit of service (UOS);
AND
Inappropriate Usage
"Do not use modifier 50 for multiple procedures on one organ, such as the skin."
"Do not report a bilateral procedure on two lines of service appending modifier 50 to the second line of service"
Can someone please help me?
Modifer 59 denials
BCBSTX has started denying claims for the -59 modifier used with 96120 and 96103. Anyone else having this problem? I feel like I’ve looked everywhere for information, and I’m just not figuring it out. Do I need to use one of the subset X modifiers?