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coding format

Kanaiyalal Posted Thu 23rd of January, 2014 10:49:47 AM

Hi - I have a quick question about coding formats. I have seen different ways of coding for multiple procedures (-51). For example with sinus procedures, if one did 31276, 31287, 31255, 31267 - all bilateral, which is the correct format to code?




SuperCoder Answered Thu 23rd of January, 2014 19:06:19 PM

Many payers including most Medicare carriers don’t want you to use modifier 51. The insurer’s software automatically sorts the procedures on your claim in order from highest to lowest relative value units (RVUs). The payer then pays the highest-ranked procedure at 100 percent and any additional surgical procedures at 50 percent. On the other hand, many Medicaid payers still require you to properly apply modifier 51.

And don’t forget only physicians and imaging centers use modifier 51, not hospitals.

Golden rule:Remember to attach modifier 51 to lower-valued code

31267-51-50 is correct

Kanaiyalal Posted Mon 27th of January, 2014 13:11:22 PM

So what you're saying for Medicare (or other payers) for example, to code for multiple procedures, they can just be listed without modifier 51 and their software will automatically assume is multiple procedures and sort them automatically from highest to lowest? I guess a call to the payers would be needed to find out what they require.

SuperCoder Answered Mon 03rd of February, 2014 09:30:54 AM

Absolutely. A payer call is the most safest method to get the more clearer picture.


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