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correct modifier ?

Nancy Posted Thu 08th of December, 2011 17:40:37 PM

Medicare denied claim due to modifier. Medicare does not accept modifier 51. What would be the correct modifier for payment.

58953
47381
39560

billed --- 58953-22
47381-59
39560-59
denied due to modifier

thanks

SuperCoder Answered Thu 08th of December, 2011 19:43:35 PM

You have billed:
58953-22
47381-59
39560-59
Denial Reason: Denied due to modifier.
*
*
Answer:
Medicare should not deny modifier 51.
It should be:
58953-22
47381-51
39560-51
Even this may also be denied due to modifier.
The key reason is not 51, but modifier 22.
Rule: When you are filing a claim with a CPT with modifier 22, you have to submit the claim with medical records with justifying documentation for modifier 22.

Nancy Posted Fri 09th of December, 2011 12:31:29 PM

Yes documentation for the modifier 22 was submitted with the claim. Medicare does not recognize modifier 51, but we will submit to see if they will pay.

Thank you

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