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Gastroenterology Coding Alert

Reader Question:

Modifier 51

Published on Mon Nov 01, 1999

Question: Your article, Correct Coding Tactics for Multiple Endoscopic Procedures (September 1999), stated not to use modifier -51 for procedures in the same CPT grouping or family. My question is, can you use modifier -51 if the procedures are in a different family, such as a patient having an esophagoscopy with biopsy and colonoscopy done with a diagnosis of 578.9 (hemorrhage of gastrointestinal tract, unspecified)?

Norvis Jones
Trenton, NJ

Answer: The CPT arranges medical procedures according to their family grouping. The colonoscopy family covers CPT codes 45378-45385. The esophagoscopy family covers CPT codes 43200-43260.

The standard way to code for these two procedures would be to list 45378 (colonoscopy) first because it has the higher relative value, and then to list 43239-51 (endoscopy with biopsy), states Pat Stout, CMT, CPC. Modifier -51 (multiple procedures) is appropriate in this case because these two procedures are not in the same family.
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