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Mariana Posted Thu 12th of April, 2012 00:03:31 AM

need help with modifier Medi-Cal denied claim States we need a modifier on CPT 31231. where can i find the required modifier ? thanks

SuperCoder Answered Thu 12th of April, 2012 06:30:28 AM

modifier 50, 80, 62, 66, 81, 82 do not apply for this code. Many other modifiers could be applicable like 22, 47, 51, 52, 53, 76, 78, 79, 58, 59 etc. It depends on the situation for which you want to add a modifier? Could you be more specific on the procedre or incidence? Was there any special situation for which you need a modifier?

SuperCoder Answered Thu 12th of April, 2012 06:32:48 AM

Use modifier -50 if the same procedure was performed on the right and left sinuses
If different procedures are performed on the same sinus on different sides, use modifier -59 on the lesser procedure.

Mariana Posted Thu 12th of April, 2012 15:40:36 PM

we medicare 99214-25, 31231, 30200-59 and medicare already paid now Medi-Cal is secondary and it's asking for a modifier on 31231? not sure which modifier to use thanks

SuperCoder Answered Fri 13th of April, 2012 09:37:55 AM

There is no CCI bundling b/w 31231 and 30200, so you can actually bill both without using any modifier. Not sure why 59 is used with 30200. Anyways, you can bill mod. 51 with secondary code which is 30200, but 51 is not mandatory. Usually systems take this directly in case of multiple reportable codes.

There is no "medical necessity" to add any modifier in particular. Please ask your secondary payer which modifier it requires. There could be certain modifier that is payer-specific and warranted.

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