Wiki Mod. to use for 20610 billing Medicare

Create Wiki
R

rjenn86

Guru
Messages
113
Location
Portland, OR
Best answers
0
I have a question and I am hoping someone is able to help me in the right direction or answer it for me.

When billing Medicare with cpt code 20610 under a PA, we used to just bill with RT and LT modifiers. Medicare is now denying them stating that the modifiers are not consisent with the procedure code billed out. We bill out under incident to guidelines, so if the PA is the one who say the patient the only thing that gets billed under the MD is the medication and the rest would go under the PA, i.e. OV and injection(s). Does anyone know where I can find this information regarding modifiers used for Medicare or has anyone else ran into this same problem? Thank you for your help in advance, it will be much appreciated :)
 
I am not seeing the entire picture here, Is the physician in the office at the time of the procedure? did the physician see the patient initially and order the injection? what dx code did you use and what was the medication.
 
If the physician is in the office, but the PA est care with the patient then we only bill the inj under the PA. The diagnosis typically used for the 20610 depending on the body part is 715.16. However it is being denied due to the modifiers we are using when it is bilateral. We attempted to bill out with mod. AS RT and AS LT, even though we didnt think that would pay and it got denied as well. We used to bill out bilateral injections with modifiers RT and LT under PA only and we would get paid and they have all of a sudden stopped paying due to the RT/LT modifiers.
 
Medicare requires bilateral procedures be billed as one line with the 50 modifier and 1 unit. you use the 50 first and the the SA modifier (not AS). ALso the dx code may be incorrect depending on which drug you are using. Some drugs treat the arthritis, but other drugs are only for pain relief so a 338.xx code would be needed.
 
We are billing in the office, for orthopedics. Not in a hospital. The dx codes I have are correct. That is not the reason for the denial. It is due to the RT/LT modifiers that they have paid in the past but now are rejecting.
 
Medicare is pretty hard over for the use of the 50 modifier for bilateral as opposed to the RT and LT. It is bill as one line item with the 50 modifier and 1 unit.
 
We bill out bilateral procedures to MCR using the RT/LT but add a 59 modifier to the second one and never get denials. If we fail to append the 59 we will occasionally have issues. If we use the 50 modifier and bill 1 unit we have significant difficulty getting paid. This is with WPS. Perhaps there is a difference between MCR payers? I do recal a situation not too long ago where MCR had a system glitch and we were getting a similar denial but called and learned of the error, we were told to just refile.
 
You both are actually correct by WPS instructions. Either way is acceptable. My question is why are you adding the SA or AS modifier? Medicare does not recognize the SA modifier and the way I am understanding the scenario the physician is not supervising the PA and did not establish a care plan. The physician must be involved in the care of the patient to bill incident to under their NPI#. The PA NPI # will reduce the payment to 85%. Modifier AS is for an assistant surgeon and the 20610 does not allow an assistant surgeon to bill this procedure, it's simply performed by a provider.

http://www.wpsmedicare.com/j5macpartb/resources/modifiers/modifier50.shtml
 
I have a related question: Can provider bill for 20610 with 23700? Manipulation done on stiff shoulder (from previous joint replacement) and after manipulated, joint was injected with Depo-Medrol. Billed with modifiers 59-51-RT. Now being audited... Would love to have resources. Thank you!
 
Mod. to use for 20610 billing Medicare

--------------------------------------------------------------------------------

I have a question and I am hoping someone is able to help me in the right direction or answer it for me.

When billing Medicare with cpt code 20610 under a PA, we used to just bill with RT and LT modifiers. Medicare is now denying them stating that the modifiers are not consisent with the procedure code billed out. We bill out under incident to guidelines, so if the PA is the one who say the patient the only thing that gets billed under the MD is the medication and the rest would go under the PA, i.e. OV and injection(s). Does anyone know where I can find this information regarding modifiers used for Medicare or has anyone else ran into this same problem? Thank you for your help in advance, it will be much appreciated


Our Family Practice Clinic bills this service if for both RT and LT as follows: 20610B this is for Mediare only. They reimburse at a higher rate since it is Bilat. (B)
 
There is no modifier B even for Medicare. So I am assuming you use the 50 for Medicare. Bilateral as one line or biled as 2 lines with Rt and LT should reimburse exactly the same . 150% of the fee schedule.
 
You must log in or register to reply here.
Top