Cardiology Coding Alert

Question: If Medicare automatically adds modifier 51 (Multipe procedures), such as to a heart cath code (93543) when a stent is also placed, do I need to add modifier 51 myself? Also the carrier has been adding mod 51 to 36246 (cath placement) and 35474 (balloon of the SFA). Is this correct? Florida Subscriber Answer: Many Medicare carriers and contractors ask that you not report modifier 51 because the carrier or contractor automatically orders the procedures on your claim and reduces payment accordingly. You should ask your specific payer if this is its preference. To determine if the fee reduction is appropriate for a specific code, you can check Medicares Physician Fee Schedule to see what the codes Multiple Surgery status is. The codes you mention (93543, 36246, 35474) all have a multiple surgery indicator of 2. This means, Standard payment adjustment rules for multiple procedures apply. If procedure is [...]