Orthopedic Coding Alert

Question: I need help understanding when to use the -51 modifier. Weve been told to use it when there is more than one surgery code billed and when there are multiple surgeries done in the same area or incision. What is correct?

Montana Subscriber

Answer: The -51 modifier (multiple procedures) should be used for all related procedures beyond the primary one. You should expect full allowance for the primary procedure. The carrier will reduce payment for any subsequent procedures. By appending the -51 modifier, youre telling the carrier which ones to reduce. The -51 modifier is only for use with surgical procedures, not evaluation and management services.

Increasingly, carriers are no longer requiring providers to use the -51 modifier for multiple procedures. Instead, computerized claims processing automatically reduces payment on subsequent procedures after the major one, making -51 obsolete. The general rule of thumb, per HCFA guidelines, is to pay 100 percent for the major procedure and 50 percent for the second through fifth procedures. Some payers still accept or require the -51 modifier though, so check with your carrier before dropping it.

Remember to bill your full charge for all the procedures, regardless of whether the -51 modifier is used. The carrier will determine by how much it wishes to reduce payment on subsequent procedures.