do I need modifiers

I have CPT® codes 49566, 11008, 44005. Do I need to use any modifiers with these codes for billing to medicare?

re: do I need modifiers

CCI edits will not allow you to bill 49566 with 44005. Lysis of adhesions is a separate procedure. Unless your doctor did an EXTENSIVE amount of lysis (hours' worth) and dictates the time and you submit the operative report, you MAY get paid. Unless your doctor REALLY deserves to get paid for 44005, I advise not billing it.

re: do I need modifiers

Thanks for your reply so quickly. The surgeon states that the mesh was not infected per say but more defective. Needed to be replaced along with the hernia repair. He also stated that the lysis of adhesions did take additional time and absolutely needed to be done. He said it wasn't hours but at least 1/2 the time was devoted to this procedure. If I put the CPT® code on the billing will they kick the whole thing out or just not pay for that particular code??

re: do I need modifiers

The insurance company will probably just not pay for CPT® 44005. You can give it a try, but in my experience, I have not gotten paid for lysis of adhesions billed with other CPT® codes; especially billed to Medicare.

re: do I need modifiers

I just found this website. Huge help!! Thanks for your help.

re: do I need modifiers

You are welcome.