Modifier Coding Alert
Separate Procedures with Modifier 51
PDF
Question: One of my surgeons did a bone flap craniotomy adopting the extradural approach in the middle cranial fossa on the left side to repair an encephalocele. He then inserted a spinal drain. Is modifier 51 the right modifier to use with 62272?
New Jersey Subscriber
Answer: If the documentation indicates the insertion of a spinal drain by the surgeon in addition to the original procedure, then you would report 62272 (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid [by needle or catheter]) along with 62120 (Repair of encephalocele, skull vault, including cranioplasty). Append modifier 51 (Multiple procedures) to 62272 to specify that the insertion of the spinal drain and repair of the encepahlocele are two different and distinct procedures.
Note: Some payers, such as Medicare, are no longer requiring the modifier 51, so you need to check with your payer to understand how they want you to submit the claim.
Modifier Coding Alert
- Specialty Focus -- Pathology:
Get the X{EPSU} Scoop and Give 59 a Rest
The future may bring clinical situations that require an “X” modifier. Medicare hasn’t offered you [...] - Outpatient Procedure:
Uncover ASC's Use of 52 with Radiology Procedures
Ignoring modifier 52 can cost your ASC thousands over time. You’ll find that Medicare’s instructions [...] - Modifier Mania:
Choose 1 of 8 Modifiers to Identify the Type of Provider
Informational modifiers can clarify who should be paid when there are multiple professionals. If you [...] - ICD-10:
Focus on ICD-10 Prep For a Smooth Transition
Upfront effort may save your practice from frustration down the road. ICD-10 implementation is only [...] - Reader Question:
Separate Procedures with Modifier 51
Question: One of my surgeons did a bone flap craniotomy adopting the extradural approach in the [...] - Reader Question:
Modifier 99 May Simplify Reporting Codes
Question: My health professional shortage area physician performs an E/M service for another physician in the [...] - You Be the Coder:
Split Post-Op From Surgical Care
Question: My group only uses modifier 55 with post-operative care. For example, when our physician is [...]