Modifier 51 vs 59

[Lisa Bledsoe]

If it's two different veins, it would be -59 (different sites).

[smcbroom]

Also remember that according to the CPT book, 59 modifier is an ASC approved modifier and not the 51 so if you are coding for an ASC which it sounds like you are not then take the 59 into consideration, but there are a few carriers such as Nevada Medicaid that like us to use the 51 modifier for multiple procedures. Just some more info for your thoughts!

[erikau]

Originally Posted by smcbroom

Also remember that according to the CPT book, 59 modifier is an ASC approved modifier and not the 51 so if you are coding for an ASC which it sounds like you are not then take the 59 into consideration, but there are a few carriers such as Nevada Medicaid that like us to use the 51 modifier for multiple procedures. Just some more info for your thoughts!

If you're doing multiple procedures, do you necessarily have to use modifier 51 since it's used as an "information only" modifier.

[FTessaBartels]

Don't know the specifics of the scenario involved ... but what about mod -76 - repeat procedure.

F Tessa Bartels, CPC, CPC-E/M

[prem_ponnuru]

Hi Mary,

I have a question do we need to append 59 mod for 28285 -TA and 28285 -59-T1. or any other same service u say.

TA and T1 or LT and RT not sufficient?

Prem.

[mbort]

I responded to your same question under another post.

[mgord]

Today during a reimbursement meeting at our wound care clinic, we were told both by the reimbursement director and an office mgr that it didnt seem to matter if you used the -51 or the -59 that they both had reduction in reimbursement. I def dont agree that it doesnt matter which one you use, I understand the reasons why you would choose one over the other. But has anyone noticed the multiple surgery cut down being applied to codes billed with the -59??

[FTessaBartels]

Remember that your reimbursement for any procedure includes the pre- and post-op care associated with that procedure. So ... Yes, you will get a multiple surgery adjustment even if you use a -59 modifier. Because the pre- and post-op care is rolled into one.

F Tessa Bartels, CPC, CEMC

[rigdon72]

Originally Posted by FTessaBartels

Don't know the specifics of the scenario involved ... but what about mod -76 - repeat procedure.

F Tessa Bartels, CPC, CPC-E/M

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I would not agree with -76 because it is a different site - not repeating the same procedure at the same site.

[mamacase1]

If a doctor does an EGD and also does a Colonoscopy on the same day in his office would you use and 51 or 59 modifier on the EGD?