Wiki -59 Modifier

[dhuff628@aol.com]

I currently work for a Chiropractor who does therapy work. 97140 & 97112. A -59 modifier has been used for as long as I have been doing his billing. Recently I have been getting paid a reduced rate on code 97140. The EOB reads: Subsequent/secondary procedure shares duplicate components of primary procedure provided on a single date of service. 1/2 the practice expense portion of this service has been reduced. Any idea what I can do to get paid for the full amount?

 

[CodingKing]

I don't think there is anything you can do. Seems this multiple procedure reduction practice continues to moving to other areas. Likely an updated payment policy may have been the issued.

For many years for when multiple surgeries are done, each additional surgery is reduced by 50 or 75% for 2nd, 3rd and so on.

Not too long ago Medicare decided when High Tech radiology scans are done on contiguous body areas they are paying the first at 100% and each additional at 50% of allowed.

You may want to contact the payer to see if they can provide you with information about the payment policy change or where in the contract it allows this.

In your PM you mentioned the secondary insurance. If what the primary allowed is less than what the secondary would allow, they will consider primary as payment in full. Sometimes they will only pay for the members copay