Wiki Medicaid FFS - Nevada - 51/59 modifiers

[Paigelyn]

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?

 

[Lajolla21]

oh the joys of medicaid.

at least you're not trying to appeal them.

here you go--there are several modifiers to choose from. 51/59 are not assigned. the fee schedule is not easy to find. the link is below if you want to bookmark it:


https://www.medicaid.nv.gov/hcp/provider/Resources/SearchFeeSchedule/tabid/528/Default.aspx

Total Records: 20
Procedure Provider Type Provider Specialty Modifier Fee Amount Age Restrictions Effective DateDescending
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 50-Bilateral Procedure $1,295.59 REGULAR 1/1/2003 - 12/31/9999
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 55-Postoperative Management $259.11 REGULAR 1/1/2003 - 12/31/9999
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 82-Assistant Surgeon (when q $172.74 REGULAR 1/1/2003 - 12/31/9999
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 50-Bilateral Procedure $2,202.50 Pediatric (age 0-21) 1/1/2003 - 9/7/2008
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 62-Two Surgeons $1,101.25 Pediatric (age 0-21) 1/1/2003 - 9/7/2008
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 82-Assistant Surgeon (when q $293.65 Pediatric (age 0-21) 1/1/2003 - 9/7/2008
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 54-Surgical Care Only $1,027.83 Pediatric (age 0-21) 1/1/2003 - 9/7/2008
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 81-Minimum Assistant Surgeon $293.65 Pediatric (age 0-21) 1/1/2003 - 9/7/2008
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY $1,468.34 Pediatric (age 0-21) 1/1/2003 - 9/7/2008
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 55-Postoperative Management $440.48 Pediatric (age 0-21) 1/1/2003 - 9/7/2008
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 80-Assistant Surgeon $293.65 Pediatric (age 0-21) 1/1/2003 - 9/7/2008
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 56-Preoperative Management O $146.82 Pediatric (age 0-21) 1/1/2003 - 9/7/2008
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 22-Unusual Procedural Servic $1,835.42 Pediatric (age 0-21) 1/1/2003 - 9/7/2008
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 81-Minimum Assistant Surgeon $172.74 REGULAR 1/1/2003 - 12/31/9999
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 80-Assistant Surgeon $172.74 REGULAR 1/1/2003 - 12/31/9999
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 22-Unusual Procedural Servic $1,079.66 REGULAR 1/1/2003 - 12/31/9999
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 56-Preoperative Management O $86.37 REGULAR 1/1/2003 - 12/31/9999
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 54-Surgical Care Only $604.61 REGULAR 1/1/2003 - 12/31/9999
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY 62-Two Surgeons $647.79 REGULAR 1/1/2003 - 12/31/9999
58552-Laparo-vag hyst incl t/o 012-HOSPITAL,OUTPATIENT 000-NO SPECIALTY $863.73 REGULAR 1/1/1981 - 12/31/9999

 

[prayercoder]

Any NCCI modifier should override the edit. 51 isn't an NCCI modifier. I suggest 59 or 76 and place it on the greater procedure which in this case is 58552. I'm not familiar with Nevada Medicaid, this is just a general suggestion.

 

[CodingKing]

Its possible they want the X modifiers instead of 59? Sometimes Medicaid has wierd modifiers requirements other than standard medicare ones. I assume it has nothing to do with the FA-50 sterilization consent form since the [FONT=&quot]hysterectomy was paid for.[/FONT]