Ob-Gyn Coding Alert

Question: Using the Resource-Based Relative Value Scale (RBRVS), what are the relative value units (RVUs) for modifiers 25, 26, 51, 52, 57, 59, and 80? Iowa Subscriber Answer: The official RBRVS assigns no RVUs to any modified code -- except for modifier 26 (Professional component) and modifier TC (Technical component). Remember, RVUs simply represent the procedure's value. Once you calculate your location's allowable, you can calculate the Medicare reduction for modifier 80 (Assistant surgeon) or modifier 51 (Multiple procedures). Under Medicare rules, a surgical assistant is paid 16 percent of the allowable, while the normal multiple procedure reduction is 50 percent of the allowable for the second through fifth additional procedure. Your payer may or may not reimburse a sixth additional procedure. Modifier 59 (Distinct procedural service) has the same reduction as modifier 51. Why: When you apply modifier 59, you usually are applying it to secondary bundled procedures. In other [...]