Wiki 51 modifier

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Texascoder64

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I have always been told we do not need to place a 51 modifier on Medicare claims and Medicare has placed the 51 during processing. It has never been an issue, but recently our MAC Novitas has been sending refund requests. When I call the rep I can not get a straight answer - Novitas places the 51 on some claims, but sometimes the others "slip" through.
Is anyone having the same issue with refund requests all of the sudden on the multi rule ?

thank you
 
I have not heard that and use the -51 modifier often with our multiple joint injections. In fact, our claim scrubbing software give me an edit, suggesting the -51 being appropriate for multiple procedures of the same nature.

example 20610 RT
20505 51 LT

I hope this helps

E
 
thank you for your response. In the past, the carrier has placed it for us, so we will not rely on this anymore and place it on the claim according to guidelines.
I have a claim edit resource and it states most carriers especially Medicare do not want you to place the 51 as their software does it.
 
Texascoder64 said:
thank you for your response. In the past, the carrier has placed it for us, so we will not rely on this anymore and place it on the claim according to guidelines.
I have a claim edit resource and it states most carriers especially Medicare do not want you to place the 51 as their software does it.
Click to expand...

I am also in the Novitas jurisdiction, and have heard on quite a few of their webinars that a 51 is not necessary, and they will place it and reduce reimbursement accordingly where necessary. I'm not aware of us receiving any refund requests lately, but I don't see things like that unless someone asks me to look into it. Is there any particular code combination that this is occuring frequently?
 
Meagan, I agree - all of the coding webinars I have been to over the past 5yrs or so state that Medicare will place the 51 as necessary and to not add it to the claim. Now all of the sudden over the past month I have received refund requests. I am in Dermatology and the main codes are primarily excision of lesion and repair codes, or MOHS with a flap or graft.

I spoke to the Novitas rep and the person I spoke to said the claim edits do not always pick up on the 51 modifier resulting in full payment, then during the post payment audits they have been doing recently is causing the refund requests. The rep could neither confirm nor deny if we need to start adding the 51 modifier. I am going to start due to this problem as I do not want to be inundated with refund requests. I have never had this problem and I have been billing for 20 yrs.
 
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