Forum - Questions & Answers

May 9th, 2016 - vernonr

can you code 45380 with 43239 modifier 51 if one is a facility charge and one is a physicians charge

May 10th, 2016 - rphelps 615  1 

re: can you code 45380 with 43239 modifier 51 if one is a facility charge and one is a physicians charge

First of all I do not use 51 anymore. Haven't in years. You cannot bill these two together on the same bill number. Why are you doing this and not bill both physician and facility on both.

May 10th, 2016 - afgbilling 59 

re: can you code 45380 with 43239 modifier 51 if one is a facility charge and one is a physicians charge

I don't understand why you would be billing both because the facility will bill facility charges and the physician will bill his/her charges separately. Also, the facility and the physician are going to have their own tax ID# therefore they wouldn't be able to be on the same claim.

May 10th, 2016 - Lupriano58 9 

re: can you code 45380 with 43239 modifier 51 if one is a facility charge and one is a physicians charge

Before I could answer this with certainty, I have to understand who you are coding for. Are you coding for 1 doctor performing both procedures being done at a facility, or are you coding for a facility? OR are you coding for 1 doctor performing 1 procedure, and a facility with the other procedure?

IF you are coding the pro fee for a surgeon (his charges) and he/she is performing both procedures AT a facility, then you would code both of these procedures on the same 1500 with a place of service either 22 or 24 depending on where the services were performed. You can add a 51 modifier if you'd like, but most insurances already do the multiple procedure discount and it really isn't necessary.

If this isn't what you are doing, then you'd have to actually explain it a little better to get a better answer. :)



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