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Modifiers 51 versus 59

Dawn Posted Wed 04th of September, 2013 11:51:19 AM

We have a claim that we billed to Medicare and it denied. This is how we coded the claim "31360" then the next line is "38724-50-51" with 2 units. The next line is "43246-51" The next line is "31611-51" and the last line is "31600". They did not pay for the "38724-50" stating that we should have used a -59 instead of the -51 on the other lines. What is the correct way that this claim should have been coded?

SuperCoder Answered Wed 04th of September, 2013 13:03:32 PM

If Medicare is directing you to use -59 modifier instead of -51 modifier you should re-bill the claim doing so. Only if they deny it again, once you follow their instructions, then we can follow up with Medicare.

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