Codapedia is now a division of Find-A-Code

Q/A: Which Modifiers to Use When Billing 44005 and 36556 Together

March 26th, 2018 - Chris Woolstenhulme QCC, CMCS, CPC, CMRS
Categories:   CPT® Coding   Modifiers   Denials & Denial Management  
0 Votes - Sign in to vote or comment.

Q: I have a denial for 44005 and 36556 being billed together. I added modifiers 51, 59, and Q6 to 36556 but I am afraid it will deny again?

A: Take a look at how you used your modifiers; you would not report both Modifier 51 and Modifier 59 on the same code.

44005 - Enterolysis (freeing of intestinal adhesion) (separate procedure)
36556 - Insertion of the non-tunneled centrally inserted central venous catheter; age 5 years or older

Modifier 51 - Multiple Procedures
Modifier 59 - Distinct Procedural Service

Modifier 59 should be appended to the “Separate Procedure” per AMA

Per AMA Guidelines, “When a procedure or service that is designated as a “separate procedure” is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/ services by appending modifier 59 to the specific “separate procedure” code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries).”

Using modifier 51 may depend on your carrier; there are some carriers that do not require the use of Modifier 51 when using this modifier you will usually receive reduced reimbursement.

Modifier 51 indicates: The same procedure performed on different sites; Multiple operations during the same session; or One procedure performed multiple times.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Small Practices are Affected by MIPS Increased Thresholds
June 25th, 2018 - Wyn Staheli, Director of Research
We recently heard about a small practice that had been faithfully submitting all the required “G” codes for the Quality Payment Program (QPP) only to discover that for 2018 they are excluded from MIPS because the low volume threshold increased from $30,000 in Part B allowed charges or 100 Part ...
How Does the Physician Compare Website Affect You?
June 25th, 2018 - Wyn Staheli, Director of Research
The physician compare website may not be working quite the way you think it is. Not all providers will have rankings showing up for them. Physician compare lists basic information, but quality measure information was not added until this year (2018) and not all quality measures are included in the ...
VA Expands Telehealth
June 14th, 2018 - Wyn Staheli, Director of Research
On May 11, 2018, the Department of Veterans Affairs (VA) released its final rule on the "Authority of VA Health Care Providers to Practice Telehealth." Effective June 11, 2018, VA providers will be able to provide telehealth services across state lines. This move will make it easier for veterans to obtain ...
Will Medicare's Proposed Reformations Affect Your Practice?
June 12th, 2018 - Wyn Staheli, Director of Research
Recently, Medicare's Innovation Center released an informal Request for Information (RFI) seeking input on several different system reformation proposals. As the market moves towards more value based payment systems, innovation and new models are being sought to both reduce costs and increase quality. This article outlines the ideas presented in the ...
Inappropriate Use of Units Costs Practice Over $800,000
June 11th, 2018 - Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
A recent OIG enforcement action emphasizes the need to understand the proper use of units. A healthcare provider in Connecticut improperly submitted multiple units for drug screening urine tests. The proper billing of units has proven to be problematic for more than just lab tests. Is your billing of drugs & biologicals, injections and timed codes appropriate?
Coding for Strains in ICD 10
May 30th, 2018 - BC Advantage
According to the National Institutes of Health, a review was carried out on 20 patients who had a pectoralis major muscle repair between 2003 and 2011, and the results were as follows....
AMA vs Medicare rules and the use of the PT modifier
May 22nd, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Be sure to review the specific payer policy you are submitting claims to. Medicare’s policy requires the use of a different code when a screening colonoscopy becomes a diagnostic procedure requiring you to bill with CPT code 00811 when treating a Medicare Beneficiary. The use of the PT modifier is ...



About Codapedia & Find-A-Code Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™/Find-A-Code™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2018 Find A Code, LLC - CPT® copyright American Medical Association