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Office visit with Uroflow

David Posted Tue 29th of September, 2015 10:48:04 AM

We have billed the following charges to insurance:

We are confident that we have hte supporting documentation for all the charges, but the payer wants there money back on 99213. I read on an AAPC thread that some payers are asking for a 51 modifier on 51741/51798 when billed with an E/M. This doesn't seem appropriate to me as there is no primary "procedure"...just an E/M. Is there any guidance on billing when these 3 services are done on teh same encounter?

Thank you

SuperCoder Answered Wed 30th of September, 2015 04:18:24 AM

Thanks for your question.

Your coding is correct. CPT code 51798 appears as a CPT code surgical code beginning with the number 5, this is a radiology code and has no associated global period. Therefore, this code can be used during a global period as well as with other E/M or surgical codes without the necessity of appending a modifier. Be aware, however, that there are some private carriers who will treat this code as a surgical code, therefore requiring a 25 modifier on an E/M service billed with code 51798 as well as modifier 51 appended to code 51798 when billed with another surgical service. that's why some payer requiring 51 modifier with 51741/51798.

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