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Modifier Help

Leorah Posted Tue 07th of March, 2017 13:16:47 PM
If I have a claim with CPT 36224 and it was done as a subsequent code to 61624 should I put my usual full billed charges for that code on the HCFA and bill it with a 51 modifier, thereby telling the insurance company to reduce payment by as much as half, or do I reduce the charges myself and expect the modifier 51 to show the insurance company that my charges have already been reduced?
SuperCoder Answered Wed 08th of March, 2017 04:26:28 AM

Hi

Appending modifier 51 to the second procedure tells the payer that the provider performed multiple procedures in the same operative session. The insurance typically reduces payment for each procedure after the first one performed. Seomtimes, modifier 51 can be taken as an informational modifier for use on the second surgical procedure performed on the same day. Processing claims electronically allows the carrier to recognize when the physician performs multiple procedures and automatically make the necessary reduction in payment. However, some smaller payers may require the use of this modifier. Before submitting the claim, please check your payer preference/method for reporting multiple surgical procedures. Hope this helps. Thanks.

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