General Surgery Coding Alert

Question: I have always thought that multiple procedures performed the same day on the same patient by the same physician generally required modifier -51 for each additional procedure. The facility I am consulting with is not appending the modifier when they bill for their physicians. Are they billing correctly?

Tennessee Subscriber

Answer: They probably are billing correctly, depending on the carrier, says Barbara Cobuzzi, MBA, CPC, CPC-H, president of Cash Flow Solutions, a medical billing company in Lakewood, N.J. Most local Medicare carriers no longer require physicians to use modifier -51, although they may append it themselves on the explanation of benefits.

The modifier has become less important with the implementation of the relative value unit (RVU) system because Medicare carriers automatically rank procedures by the number of RVUs assigned to their corresponding CPT codes. Many private payers also no longer require modifier -51. Some Medicare and commercial carriers still want modifier -51 appended to multiple procedures, however, so be sure to know the policy of your carriers.