Wiki Holter monitor 93224

[cmurphy52]

Is anybody having a problem with Medicare appending the 51 modifier to a Holter monitor billed independently of any other service (day it is returned and read). We are billing it as a stand alone code and Medicare is appending the 51 modifier putting it in the multiple procedure category because it also has a TC/PC code which we do not use but the global code since we own the equipment and read the test. The reimbursement is even less for billing 93225/93226 because Medicare appends the 51 modifier on 93226. I have tried appealing but for some reason they have these procedure flagged as multiple procedures even when they are the only code billed on that day of service.

 

[jennbrinegar]

We bill the full component where I work. We rarely use the 51 modifier. However, when we run into a problem with 93224 it is when we have an ekg for that same day. At that time, we add the 59 modifier to the ekg and we are getting paid. I don't know if this information would help you at all.

 

[cmurphy52]

That is the problem. Medicare is automatically applying the 51 modifier and withholding the multiple procedure reduction for that code even though it is billed completely independent of any other code.