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Question: Our general surgeon removed a 2.5 cm benign lesion from the patient’s upper back and, in the same operative session, also removed a separate 1.5 cm benign lesion from the left forearm. Both procedures were medically necessary and performed by the same physician on the same date of service. Neither procedure code is an add-on code. Should I append modifier 51 or 59?

Colorado Subscriber

Answer: Modifier 51 (Multiple procedures) may be your best bet in this scenario rather than modifier 59 (Distinct procedural service) based on the facts presented: The same physician performed multiple procedures during the same operative session, the excisions involved separate benign lesions at different anatomic sites, and neither procedure code is an add-on code. Those circumstances support appending modifier 51 to the secondary procedure — when required by the payer.

Before appending modifier 51, confirm that the CPT^® code is not modifier 51 exempt, and check the payer-specific guidance. Some payers, including Medicare, may apply multiple-procedure reductions automatically rather than requiring modifier 51 to be appended.

Generally, modifier 59 is appropriate only if the procedures were subject to a National Correct Coding Initiative (NCCI) edit and the documentation supported that they were separate and distinct. If an edit exists, modifier 59 or XS (Separate structure) may be necessary when supported by the documentation; if no edit applies, you don’t need modifier 59.

This scenario doesn’t suggest any edit conflicts requiring modifier 59, and excisions of separate lesions at different sites may be separately reportable without it.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC