modifier

  1. T

    Wiki Modifier 57 - abdominal adhesions

    Pt having 58720 and during surgery realized that the pt had dense pelvic and abdominal adhesions. They used 58720-57 and 58740. I am not sure that modifier 57 is correct. Lysis of adhesions is usually an included procedure unless it adds significant additional work. The notes state that they...
    • tracylc10
    • Thread
    • 58720 58740 adhesions dense modifier
    • Replies: 2
    • Forum: Modifiers
  2. L

    Wiki Modifier XS

    Should we be using modifier XS when an outpatient is receiving--for example--and IVP and also IM/SQ injection(s)? Should it be used on the injection(s) and each injection on a separate line?
    • ljohns31
    • Thread
    • injection injections line modifier separate
    • Replies: 2
    • Forum: Modifiers
  3. T

    Wiki Humana denial

    Our patient underwent carpal tunnel surgery. Humana has denied the claim stating a modifier is required for this procedure. The other coder in our office & myself were discussing the fact that since ICD-10 has expanded diagnosis codes (like this one) to included specific location, is a...
    • tmarugg
    • Thread
    • humana icd-10 modifier required specific
    • Replies: 3
    • Forum: Modifiers
  4. U

    Wiki Colonoscopy in outpatient setting

    Hello. Wanted to get some clarification. :) Colonoscopy- physician introduced scope through anus and advanced to the terminal ileum, with ID of the appendiceal orifice and IC Valve. The colonoscopy was performed without difficulty. The quality of the bowel preparation was fair to poor. He did...
  5. P

    Wiki modifier 62 with 22

    Can a surgeon use a co-surgeon (modifier 62) and also use the modifier 22? Or does the 62 modifier automatically exclude use of the 22
    • pgirkins
    • Thread
    • automatically co-surgeon exclude modifier surgeon
    • Replies: 0
    • Forum: Modifiers
  6. D

    Wiki Performing an IME and Taking x-rays

    My doctor, in Nevada, has just recently started performing IME's and usually takes x-rays when doing so. Is there a modifier that needs to be used for those x-rays?
    • devonnisson
    • Thread
    • doctor modifier performing taking x-rays
    • Replies: 0
    • Forum: Modifiers
  7. L

    Wiki ESSURE modifer - We are having claims

    We are having claims denied for lack of modifier on our ESSURE claims. We use 58565 and A4264, and one denial specified that the A4264 needs a modifier. We have tried mod 50 but that was denied. Thnx for any suggestions!
    • lizelder
    • Thread
    • a4264 claims denied essure modifier
    • Replies: 1
    • Forum: OB/GYN
  8. L

    Wiki ESSURE modifer - IN SC we have recently

    IN SC we have recently had our ESSURE claims being denied for lack of modifier on the A4264 portion. We have tried mod 50 but that did not work. Is 33 the appropriate modifier? Any thoughts would be appreciated!
    • lizelder
    • Thread
    • appreciated denied essure mod modifier
    • Replies: 0
    • Forum: Modifiers
  9. A

    Wiki do you need a modifer when using 97032

    I have just received a denial on a claim that I submitted to Tufts. I am working for a chiropractor and I have used 97032 before with no modifier used and now I get the denial CO-182 meaning Payment adjusted because the procedure modifier was invalid on the date of service. This has never...
  10. D

    Wiki Medicare payment of Code 29581

    Is anyone having difficulty getting payment from Medicare on this code post-op or after fx care management. Our clearinghouse instructed us to use a 58 modifier and a LT or RT modifier but they are still being rejected.
    • diloretoe
    • Thread
    • code medicare modifier payment rejected
    • Replies: 0
    • Forum: Podiatry
  11. K

    Wiki modifier 80 and 78 to medicare - Need help with this

    Need help with this. One of our docs assisted an OUTSIDE doc on CPT 35665 and 37618. I know I need modifier 80. Here is the dilemma ....this procedure takes place within the global period for a DIFFERENT procedure that one of OUR docs did. Do I also need modifier 78 along with the 80 because...
    • ksrkelly7
    • Thread
    • doc global modifier period procedure
    • Replies: 1
    • Forum: Modifiers
  12. K

    Wiki modifier 80 and 78 to medicare

    Need help with this. One of our docs assisted an OUTSIDE doc on CPT 35665 and 37618. I know I need modifier 80. Here is the dilemma ....this procedure takes place within the global period for a DIFFERENT procedure that one of OUR docs did. Do I also need modifier 78 along with the 80 because...
  13. C

    Wiki Screening Colonoscopy and Anestheisia

    Screening Colonoscopy and Anesthesia If a patient is having a screening colonoscopy G0121, G0105, or 45378-33. Lets say a non-medicare patient was coded with a G0121 and DX Z12.11. G0121 is accepted by most commercial insurance companies so this should be fine. When its time to bill...
  14. T

    Wiki modifer help Please

    We have a new computer system. We are running into a problem I haven't had before. A patient comes in for either a physical or AHA (G4038/G0439). If they have other problems we bill a E/M (99213)code also. Then if they have eg: 17000,20600,17110 etc. done I usually bill as follows. 99396/G0439...
  15. M

    Wiki Coding of Locum Tenem in the Emergency Setting

    I have always been under the impression that when a Locum is working that we are to put the Q6 modifier on anything that they do. Am I correct in my thinking? Where I work they now after 3 years of putting the Q6 on the codes that they have always overridden the Q6 to bill to the doctor that is...
  16. L

    Wiki Mediccare denial for 65855

    We billed 65855 RT for a trabeculoplasy of the right eye and Medicare has denied stating the procedure modifier is inconsistent with the procedure code or a required modifier is missing. What am I missing? Thanks for any input.
  17. S

    Wiki **** Humana is fixed**** innaproptiate denials of well visits

    After working the insurance commissioner and Humana all claims processed from 12/12/15 to 01/16/16 should be reprocessed and paid correctly. They stated that there was an internal error where claims with a 25 modifier and 59 modifier were being denied incorrectly. I was able to locate a claim...
    • ssharp
    • Thread
    • 01/16/16 claims denied humana modifier
    • Replies: 0
    • Forum: Pediatrics
  18. S

    Wiki ****HUMANA is Fixed ***** denials of well visits with immunizations

    After working the insurance commissioner and Humana all claims processed from 12/12/15 to 01/16/16 should be reprocessed and paid correctly. They stated that there was an internal error where claims with a 25 modifier and 59 modifier were being denied incorrectly. I was able to locate a claim...
  19. L

    Wiki charging Interpretation for PFT

    My Dr is questioning whether we can charge for PFT interpretation only. Never having done this before I wanted to see if anyone else does. I think it would work if I used 94010 with a 26 modifier. Does anyone do this? The test is performed at the local hospital and my Doctor is only providing...
  20. J

    Wiki PT/INR and E/M with modifier 25 in Long term care

    It has been my understanding that billing an PT (85610) is only for the PT itself and not for the adjustment of the dosage of the medication. Since I work in long term care I have the question on if a low level E/M visit (99307) can be billed with a 25 modifier with a (85610) if an adjustment...
  21. K

    Wiki Co-Surgeons -- Modifier 62

    Hello all, I'm having a hard time distinguishing the proper use of modifier 62. In almost all Medicare articles they constantly state "when two surgeons (different specialties) perform a surgery...." that makes me think that they have to be from two different specialties. However when they give...
    • KJenkins588
    • Thread
    • knee modifier replacements specialties surgeons
    • Replies: 5
    • Forum: Modifiers
  22. K

    Wiki Gastroenterology - I have a claim that Medicare denied procedure

    I have a claim that Medicare denied procedure 97605 when billed together with 20102 stating invalid modifier billed with 97605. The procedures were billed as 20102-78-GC and 97605-59-78-GC. I verified in NCCI and these modifiers are appropriate. Does Medicare not want the modifier 78 on...
  23. D

    Wiki E/M w/ 57 modifier and operative report denial

    We have seen an influx of denials from payer sources (VA, BCBS and work comp) denying the E/M with a 57 modifier because the E/M and operative services weren't billed on same claim. Is anyone else seeing this? Thank you. Deb Knight, CPC, COC Missoula Bone & Joint & Surgery Center
  24. R

    Wiki Transitional care and smoking cessation

    I have billed 99496 transitional care with modifier 25 and 99406 smoking cessation. New 2016 guidelines have stated that transitional care can now be billed on the day of the face to face visit that's why they were billed together on the same day. I received a denial saying the procedure code...
  25. P

    Wiki Medicaid FFS - Nevada - 51/59 modifiers

    I bill for an OB and am trying to bill 58552 with 57282. These two codes do allow a modifier. Medicaid keeps denying for incorrect modifier. We tried 51 and 59 on the 57282. Any thoughts or is anyone else having this issue with NV Medicaid?
  26. S

    Wiki Inpatient Coding - Could anyone tell me how

    Could anyone tell me how are the codes 31500,36556,92950 and 99291 are to be billed and if a modifier is needed. The clearing house is stating that there is a CCI conflict edit within the claim.
  27. L

    Wiki Billing Proctored Cases

    Dr. A. is proctoring Dr. K. in abdominal aortic endografts. Based on the dictation, it looks like Dr. K. was the primary operator, but Dr. A was also listed. Would a modifier -62 be the most appropriate in this case, or does the fact that it's a proctored case change things? Thank you! Edit...
  28. R

    Wiki Modifiers 25 and 57

    How do I do this? New inpt initial hospital care (99221) with the decision for both procedures (19303, 90 day global) & (36561, 10 day global). Medicare patient. I used the 57 modifier on the 99221. Medicare denied 99221 so we appealed. This is the response from Medicare: We received an...
    • rhaney1033
    • Thread
    • major minor modifier modifiers surgery
    • Replies: 1
    • Forum: Modifiers
  29. T

    Wiki Smoking and tobacco use cessation

    Is anyone having a problem getting these codes paid 99406 or 99407. We are using dx F17.210 along with whatever problem the patient came if for and with the proper documentation of the provider counseling the patient. We are also adding a 25 modifier on the office visit. Is there something...
  30. C

    Wiki Is the Q0 modifier required for OP Medicaid Patient getting an AICD?

    I am curious if the Q0(zero) modifier is required to be added to CPT 33249 for patient undergoing a OP procedure for implantation of an Automatic Implantable Cardiac Defibrillator primary prevention. I know thi sis required for Medicare. I am unsure is this applies to Medicaid. Any help would...
  31. J

    Wiki Modifier 26

    May modifier 26 ever be used with an E/M code? Thanks!
    • jannacrock
    • Thread
    • bariatric center code e/m modifier
    • Replies: 1
    • Forum: Modifiers
  32. F

    Wiki Out Patient Hosptial Modifier

    Good Morning , Can you please let me know your thoughts on this. Should a TC modifier be applied to cpt 76000 on an outpatient hosptial billing. (actual facility charge) I have never heard of this, but am being told this has changed as of 01012016. I cannot find any information regarding...
  33. N

    Wiki Inpatient admit and consult code - modifier 25?

    Patient was admitted to hospital (99221) for DVT and later that day a specialty physician for pain management did a consult (99254) which was paid. The denial is stating the 99221 is inclusive with the 99254. Is it possible to add a modifier 25 to the 99221 even though only the consult was...
    • nantes1993
    • Thread
    • 99221 99254 consult inclusive modifier
    • Replies: 2
    • Forum: Modifiers
  34. O

    Wiki Needing Help Coding Office Visit!!!

    Our physician saw a patient under observation status in the hospital, and then saw him in the clinic for the first time as a new patient. We billed the hospital consult with an e/m office visit code, saw him in the office and did surgery the following day. We used a modifier 57 on this visit...
    • Orthocoder269
    • Thread
    • hospital modifier office patient visit
    • Replies: 0
    • Forum: E/M
  35. M

    Wiki Nursing Facility charges

    I work for an ANP and FNP who occasionally see patients at our local nursing facility. I have used the code 99334 with place of service but am getting denied by Medicare saying that the procedure code is incosistent with the modifier used or a required modifier is missing. When my providers...
  36. L

    Wiki bialteral modifiers with 31297, 31295 and 31255

    Can these codes be used with modifier 50? and on the same claim as 31296?
  37. D

    Wiki coding question 29880 and 29877

    cpt 29877 and 29880 I know should never be billed together, however when the dr. does a shaving in a different part of the knee, would I be able to append modifier 59?
  38. M

    Wiki modifier 24 - I have a biller

    I have a biller who says a 24 modifier is appropriate on a claim and I question the validity. Looking for validation for the following scenario: Patient had several procedures in June 2015, only 1 of which has a 90 day global, CPT 46930 Destruction internal hemorrhoid. In early Sept 2015, still...
    • melaapc04
    • Thread
    • global surgery modifier modifier 24 note patient
    • Replies: 3
    • Forum: Modifiers
  39. L

    Wiki Bilateral Knee xrays

    Did something change with coding bilateral knee xrays? We use to bill 73560-50, but it looks like the 50 modifier is not longer allowed.
  40. A

    Wiki modifiers 76 vs 59

    When billing for spinal cord stimulators WITH 3 LEADS plus an epiducer I have been billing as follows : 63650- LT, 63650-RT AND 63650-59. I have recently heard that the 76 modifier should be used instead of the 59. Can anyone shed some light on this please? Thank you
    • ahachmann
    • Thread
    • billing heard light modifier recently
    • Replies: 2
    • Forum: Modifiers
  41. R

    Wiki Problems with deciding whether a modifer 50 should be used or right and left

    I have noticed that different insurance companies are requiring right and left when performing bilateral procedures vs the 50 modifier (bilateral procedure). Does anyone have documentation on what Tricare demands? I cannot get an answer from them. Would appreciate any help you can give me...
    • rmalashuk
    • Thread
    • bilateral demands left modifier tricare
    • Replies: 1
    • Forum: Modifiers
  42. J

    Wiki how to code a second EGD during a post-op period

    The surgeon I work for performed an EGD and Colonoscopy on this particular patient, and about 3 weeks later he does an EGD with placement of percutaneous gastrostomy tube, 5 days later a tracheostomy, now another 3 weeks later he does an EGD should I have billed this EGD with a modifier? The...
  43. M

    Wiki hand/finger tendon conrtractures

    I am trying to code a hand/finger surgery in which the surgeon did a release of tendons. Its on the right hand and each finger had 2 tendons, except the thumb which only had one. I have coded by just using 9 units and received a denial and I have also listed each tendon with a finger modifier...
  44. C

    Wiki NC Tracks(NC Medicaid) and assistant to surgery Modifier denial

    Good Morning, Just wondering if anyone else is having trouble getting paid for assistant to surgery for PA's. We are filing with CPT code 37225- 80. Medicare is paying as primary and then medicaid denies stating CPT/modifier combo is invalid. When the AR girls call NC Tracks all they will tell...
  45. T

    Wiki 63047 denying for modifier ....

    Recently Tricare began denying 63047 stating "...INHERENT BILATERAL PROCEDURE WITH UNITS GREATER THAN ONE...." The procedure done was "DECOMPRESSION OF L3 & L4 LAMINECTOMY WITH BILATERAL FORAMINOTOMIES" The original claim was sent with 63047 x1 & 63048 x1 & 69990 x1. According to the CPT...
  46. Y

    Wiki HCPCS code modifiers

    Medicare requires modifier w/A4352, A4402-This is new. What modifier should we use?
    • yueliuvb6
    • Thread
    • code medicare modifier modifiers w/a4352
    • Replies: 1
    • Forum: Modifiers
  47. D

    Wiki 29827 rt 29822 rt

    I know these codes use to have edits but when I put them together in medicare cci edit it says stands of medical surgical practice with 1, does that mean its okay to bill without modifier also McKesson says its allowed without any issue, I would appreciate anyones help thank you
  48. T

    Wiki Would you use mod 25 or 59

    When reporting codes 99204 and 96103, would you use modifier -25 or -59? for non-medicare and medicare cases...
    • tvaughn
    • Thread
    • medicare mod modifier non-medicare reporting
    • Replies: 3
    • Forum: Modifiers
  49. L

    Wiki Modifier 57 - variety of payers

    Hello, I am seeing a lot of denials by a variety of payers for the E/M code with 57 modifier when a surgery is done the same day or day after. Is anyone else seeing this? We have been appealing with no success. I am not sure what the increase is caused by but we are following CMS guidelines...
  50. M

    Wiki flexion hand contractures and felxor tendons

    I am trying to code a hand/finger surgery in which the surgeon did a release of tendons. Its on the right hand and each finger had 2 tendons, except the thumb which only had one. I have coded by just using 9 units and received a denial and I have also listed each tendon with a finger modifier...
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