Forum - Questions & Answers

Oct 26th, 2016 - Hgpc1007 2 

Flex Sig/Hemorrhoid Ligation

We are getting denials from Medicare when preforming the Flex Sigmoidoscopy and Hemorrhoid Rubber band Ligation during the same session in an Ambulatory Surgical Center. We append the 51 modifier to show that the two CPT's are separate and distinct services rendered during the same operative session. The Flex Sig is the primary procedure, so the modifier is on the Ligation. Medicare pays the lesser of the two charges which is the Ligation and denies the Flex Sig saying that payment is included in the payment of the Ligation because these two CPT's are bundled and no further payment will be issued. Is anyone else having problems with two services being provided in the same session getting denied at all. Or does anyone else do the Flex Sig and Hemorrhoid Ligation on the same date of service? Any help with getting around this issue is greatly appreciated, we look forward to your response! Thank you all!!

Oct 27th, 2016 - rphelps 615  1 

re: Flex Sig/Hemorrhoid Ligation

51 would not be the correct modifier. Try putting a 59 on 45330. 51 is a multiple procedure modifier. 59 is seperate service.

Oct 27th, 2016 - Hgpc1007 2 

re: Flex Sig/Hemorrhoid Ligation

I will try that, Thank you for the response!!

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