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lyp0a220

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Hello Everyone,

Does Medicare HMO Plans get the 51 modifier or the 59 modifier. Two codes I am trying to bill-out together is 19316, and 19342 I know they are mutually exclusive but you can bypass the edit with the correct modifier. I have tried both the 59 and the 51 and keep getting the same error.

Thanks :confused:
 
Yes I was but realized it should only be added t the 19316 is this what you were suggesting? Thanks for responding! ;)
 
The AAPC coder is showing the 19342 as the primary procedure with a 59 modifier and then the 19316 as the secondary procedure with a 51 on it. Have you tried this?
 
No, I have not tried this combination yet thanks I will pass it along to see if this works. I have to wait to hear from the billing office. 19342 is my primary procedure with 19371, 19316, 19380 billed together. Do I still need to append 59 to this first code i thought it was secondary and beyond gains the modifiers as I don't want my highest paid to be reduced because of the modifier. Here are my thoughts let me know if you have different thoughts:
19342-RT
19371-LT, 59
19316- LT, 59
19380-RT, 59

Medicare advantage plan is the payer for this one. I know the modifier rules maybe a little different. Thanks
 
When I check the codes I am showing that they should be

19342-59
19371-59
19380-59
19316-51

These codes are all bundled but adding the 59 on them unbundles them from each other. If these are all completely separate procedures then make sure you bill with the 59s.
 
Thanks what are you using to check them? Are you using the Super-coder or something different? Thanks again for your response. I do appreciate the assistance:eek:.
 
Thank you I am new to AAPC and learning the tools that are available to me would you mind sharing where its located and how I can access it? I am the only coder in my office so there is no one else to ask in the office I would have to look to another office to find out. If not it is fine thanks so much for your help so far it is greatly appreciated.
 
It is located under Resources-Coding/Billing Solutions. It is a tool that requires a paid monthly or yearly subscription separate from the AAPC membership.
 
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