Cardiology Coding Alert

Reader Questions:

Learn Modifier 51 Guidance

Question: There has recently been an argument in our department regarding modifier 51 for diagnostic imaging. I think diagnostic imaging should not need the modifier, since it’s more of a “surgical modifier.” But I can’t find anything to support that. Can we use modifier 51?

Ohio Subscriber

Answer: Medicare defines modifier 51 (Multiple procedures) as being used for multiple surgeries or procedures, such as:

  • Multiple surgeries performed on the same day, during the same surgical session.
  • Diagnostic imaging services subject to the multiple procedure payment reduction that are provided on the same day, during the same session by the same provider.

So, it’s possible that if your primary care practitioner (PCP) has access to the technology, modifier 51 may be appropriate for some of those diagnostic imaging services.

However, you should append the modifier with caution. Several Medicare Administrative Contractors (MACs), including Novitas Solutions, advise coders not to use this modifier because their claims software will append it automatically to the correct procedure code as appropriate (https://www. webcenter/portal/MedicareJH/ pagebyid?contentId=00144532). If the payer’s system recognizes and accepts multiple procedures without the modifier, then it will kick back the claim if the modifier is present.

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