Cardiology Coding Alert

Question: Our cardiologist often performs multiple procedures. Do I have to append modifier 51 every time?

Idaho Subscriber

Answer: No. Medicare and many other payers do not want you to use modifier 51 (Multiple procedures). Those payers use software to apply the multiple procedure reduction.

If you do need to append 51 (some practices even like to use it for tracking), you should never append modifier 51 to any of the following:

• Add-on codes, which the AMA 2017 CPT^® manual lists in Appendix D and identifies with a + symbol in the code set
• Codes in Appendix E of the AMA 2017 CPT^® manual; the codes in Appendix E are marked with a symbol in the code set
• Codes that have modifier 50 (Bilateral procedure) appended and therefore already have a fee reduction
• E/M services
• Physical medicine and rehabilitation services
• Provision of supplies.

To use modifier 51 correctly, you append it to subsequent procedures, such as the second, third, or fourth, if the same physician performs multiple procedures for the same patient during the same encounter.

Situations where you can append modifier include if the physician performs the same procedure on different anatomic sites, if the physician performs different related procedures on the same anatomic site, or if the provider performs the same procedure on the same anatomic site multiple times.

Cardiology example:  Look up 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) in the 2017 CPT® manual, and you'll notice the "modifier 51 exempt" symbol to the left of the code. That means when the cardiologist performs the catheterization in addition to another procedure, you should report 36620 without modifier 51. The claim should also include the codes for any other reportable procedures the cardiologist performed.