ED Coding and Reimbursement Alert

'Circle with a slash' sign indicates modifier -51 exempt code

Think you're ready for claims using modifier -51 (Multiple procedures)? Not if you don't know the exceptions to the modifier -- and how to spot them.

Appendix E of CPT 2004 contains a list of codes that are exempt from modifier -51. The list is "a summary of CPT Codes that are exempt from the use of modifier -51 but have not been designated as CPT add-on procedures/services," according to CPT. These modifier -51 exempt codes are also recognizable within the code listings of CPT; just look for a "circle with a slash" symbol to the left of the code.

To prevent red tape and increase your practice's productivity, get to know the exemptions before filing a claim with modifier -51.

Example: A patient presents with a pneumothorax and is in extremis. The physician intubates the patient before putting in a chest tube.

You would report 31500 (Intubation, endotracheal, emergency procedure) and 32020 (Tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema] [separate procedure]) without appending any modifiers. Both of these procedures are listed as -51 exempt in Appendix E of CPT, so there is no need to append the modifier to either code.