Billing Multiple Procedures Requires More Than Modifier -51
Published on Sun Aug 01, 1999
When two or more procedures are performed by a physician in the office on the same day, they are categorized as multiple procedures. Otolaryngologists often perform two or more procedures the same day, and billing them correctly can be deceptively complicated.
At first glance, billing for multiple procedures would not appear to be all that difficult. CPT 1999 clearly indicates that modifier -51 (multiple procedures) should be attached to any additional procedure when multiple procedures, other than Evaluation and Management (E/M) services, are performed at the same session by the same provider. CPT goes on to say that the primary procedure or service may be reported as listed. The additional procedure(s) or services may be identified by appending the modifier -51 to the additional procedure or service codes.
Medicare requires the use of modifier -51 for secondary procedures when you have different procedures on the same day, says Emily Hill, PA-C, the managing partner of Strategic Healthcare Services and a member of the American Medical Associations Relative Value Update Committee, representing the American Medical Associations Health Care Professionals Advisory Committee Review Board. Hill also serves on the AMAs CPT-5 Project and Correct Coding Policy committees.
However, modifier -51 does not cover all scenarios involving multiple procedures. Some are bundled to primary procedures with global periods, while others may be entirely distinct from the primary procedure. Furthermore, some third-party payers differ from Medicare guidelines that mandate modifier -51 for most multiple procedures.
In addition, there are 85 procedures listed in
Appendix F of CPT 1999 that are exempt from modifier
-51, as are add-on services that are always done in conjunction with other procedures, which have had their value already reduced.
Note: Most carriers will reimburse a procedure with an attached -51 modifier at a 50 percent rate.
Coding a Typical Multiple Procedure
In the following case, the patients pre-op diagnosis was serous otitis and tonsillectomy and adenoidectomy (T&A) hypertrophy; in the post-op report, a large retropharyngeal lymph node was added. The otolaryngologist excised the retropharyngeal lymph node, performed a bilateral tympanotomy and tube, as well as a T&A.
According to the operative note:
The patient had enlarged adenoids and huge tonsils but when we removed the tonsils there was a large mass in the retropharyngeal space just to the right of the midline. At first I thought it was an anomalous carotid artery but on palpitation there was no pulsation. It was a round moveable mass, fairly firm. I suspected it was a lymph node but [...]
