Gastroenterology Coding Alert

In the September 1999 Gastroenterology Coding Alert, the article Correct Coding for Multiple Endoscopic Procedures on page 4 advocated use of modifier -59 (distinct procedural service) when coding for a colonoscopy with polypectomy and a biopsy done at a different site or area than the polyp removal. In the October issue, the article Two Methods for Improving Reimbursements of Colonoscopies With Multiple Removal Techniques on page 9 addressed the use of modifier -51 (multiple procedures) when coding for a colonoscopy with polypectomy that used two different methods (hot biopsy forceps and the snare technique) to remove polyps in the colon.

Part of the confusion over what modifier to use comes from a failing to clearly explain the differences in the coding situations highlighted in these two articles. Whether the two procedures are performed in different areas of the colon or the same significantly can change how they are billed and reimbursed.

Modifier -59 should be used to designate separate procedures. An article on the use of the modifier in the July 1999 issue of the CPT Assistant states, This indicates that the procedure is not considered a component of another procedure, but a distinct, independent procedure, such as a:

- different session or patient encounter;
- different site or organ system;
- separate incision/excision;
- separate lesion; or
- treatment of a separate injury (or area of injury in extensive injuries).

Modifier -51 should be used to indicate multiple procedures. The same CPT Assistant article states that modifier -51 has four applications, namely to identify:

- multiple medical procedures performed at the same session by the same provider;
- multiple, related operative procedures performed at the same session by the same provider;
- operative procedures performed in combination at the same session, by the same provider, whether through the same or another incision or involving the same or different anatomy; and
- a combination of medical and operative procedures performed at the same session by the same provider.

Determining whether to use modifier -51 or -59 can be confusing if gastroenterologists try to commit a set of rules and situations to memory, says Pat Stout, CMT, CPC, an independent gastroenterology coding consultant. In her opinion, the best resource is the Correct Coding Initiative (CCI), which was adopted by Health Care Financing Administration (HCFA) to avoid payment of incorrectly coded claims.

If the CPT code for a medical procedure is listed in the CCI as being bundled into the code for another procedure, then Medicare will not reimburse for [...]