Neurology & Pain Management Coding Alert

Question: Our neurologist often performs multiple procedures during the same encounter. Should I append modifier 51 every time?

Idaho Subscriber Answer: No, you should not always append modifier 51 (Multiple procedures) in these situations.

The CPT manual designates some procedures as being -modifier 51 exempt- with a X symbol to the left of the code. You also do not append modifier 51 to add-on codes (designated with a plus symbol before the code).

Your manual may also offer a complete list of modifier 51 exempt codes in an appendix. The list is a -summary of CPT codes that are exempt from the use of modifier 51 but have NOT been designated as CPT add-on procedures/services,- according to CPT 2007.

Important: Many payers -- including most Medicare carriers -- don't want you to use modifier 51. The payer will automatically sort the procedures on your claim in order from highest to lowest RVUs. The payer will reimburse the highest-ranked procedure at 100 percent and any additional surgical procedures at 50 percent.

Final note: Remember that only physicians and imaging centers use modifier 51; hospitals don't report it on their claims.