Wiki Is modifier 51/59 still necessary?

[cottrellk1]

I am coding GI and I have read (and searched) articles regarding the correct use (or not) for modifier 51 and/or 59 on nonbundled CPT codes. I am extremely confused. Ex) 43239 and 45385 do not bundle but they are in two separate areas???? Does anyone have any links or updates to share? Thank you. -Cottrellk1

 

[luhre]

Coding/Data Analyst CPC

In this case, because 43239 is a different family, you apply modifier 51 to 43239 not 59.

 

[tdvrana]

51/59

I was of the understanding that Medicare is not accepting 51 any longer. I have even gotten denials just because I used it. I code 45378 and 43239 together a lot as I code for a general surgeon, and we get paid on them using only 59. I don't know if I'm right or wrong but that's what we're doing now.

 

[Anitha Lingala]

Since there is no bundling issue with the two codes, modifier 59 cannot be abused.

 

[ToniasCertification]

59 Modifier

CMS no longer recognizes modifier -59. They are using the X modifiers instead. -51 modifier is still applicable.

 

[qbchristine@gmail.com]

Modifier 59

I work for a pain management doctor and we are now having trouble getting paid for 77003 when billed with 62311. We used to get paid when we billed it with modifier 26, this is for the professional component. But now it is considered a bundled code. If we bill it with modifier 26 and 59 it gets paid but I am not sure if that is correctly billed? Anyone have any suggestions?

 

[AR2728]

Regarding 62311 and 77003:
We too had issues beginning this year, but noticed there was not change to CCI edits to include 77003. We did receive clarification from our carrier that it is appropriate to add 59 along with 26 to receive reimbursement for this service.

 

[mhstrauss]

Regarding 62311/77003--Effective this year, 4-1-15 I believe, fluoro guidance is bundled with the ESI code, per Medicare CCI edits. It would not be appropriate to use mod 59 on the fluoro code UNLESS the fluoro was used for a separate procedure on the same DOS, NOT used for the ESI.

 

[ollielooya]

Actually, Medicare does still allow the use of modifier 59, but they are carefully watching to see how these modifiers are applied. They are advising to carefully consider the use of the more specific X{ESPU) modifiers. We've used both so far this year and have had no issues. In time, they may phase out 59, but for now it still is accepted..

 

[Coleene]

Modifiers 51 for GI ASC

We are an ASC and have been using modifier 51 to the second procedure when we file a claim for a 43239 and 43450-51. Recently we received an EOB from Medicare that reversed the 51 to the 43239. They did not make any corrections to the EOB. They also moved the 51 to the 43235 when it was billed with the 43450. Can anyone tell me if Medicare does not except the 51 modifier for multiple procedures and if any one else is having this happen?