Wiki medicare adding 51 to procedures??

[kristenw]

Has anyone noticed medicare automatically adding modifier 51 to procedures that were performed on the same such as an echo and a nuclear study they are automatically reducing the payment. Modifier 59 was added already when original claim was sent out.
what has been your experience with Medicare with this???

 

[ajb1986]

They do that to us a lot. What you need to watch for is if the codes they are adding 51 modifiers are "51 exempt." what I mean by that is some codes you do not have to put 51 modifier on them because the AMA says they are not subject to a multiple procedure reduction. The AMA puts out very well written books on codes. Our office has one specifically for our practice. each procedure code gets a page dedicated to it where you can see what you can and cannot bill with that code.

If these codes are 51 exempt then you will have to appeal it. If your documentation is good they should overturn it.

 

[Amanedmaiston]

Medicare will add a 51 modifier to codes that the multiple procedure reduction applies too. This is new for stress and echo in 2013. However you do not need the 59 modfier on those codes.