Cardiology Coding Alert

Question: Do I need modifier 51 to report E/M (99214), ECG (93000), and venipuncture (36415)?

Codify Subscriber

Answer: Modifier 51 (Multiple procedures) use is payer specific. Many payers, including Medicare, prefer that you not use modifier 51 because the payers weight the codes themselves. For example, Part B MAC WPS states, “Medicare does not recommend reporting Modifier 51 on your claim; the processing system has hard-coded logic to append the modifier to the correct procedure code” (http://wpsmedicare.com/j5macpartb/resources/modifiers/modifier-51.shtml).

This combination of services is not a likely scenario for modifier 51 use.  Modifier 51 would be more appropriate in a case with multiple similar services, such as multiple surgical services.

You may need modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) on the E/M code, depending on your payer.