Part B Insider (Multispecialty) Coding Alert

Published on Tue Jan 20, 2004 PDF

Use modifier -59 when procedures are totally separate

Two procedures, one day. Which modifier should you use? When you have two surgeries or other non-evaluation and management procedures on the same day, you reach for a modifier to explain what happened and override National Correct Coding Initiative edits. But you have two possibilities: modifiers -51 (Multiple procedures) and -59 (Distinct procedural service).
 
Many coders aren't sure when to use modifier -51 rather than -59. But the differences are pretty clear-cut. You should use -51 when you're performing multiple services and want to show that you're not making an error when submitting the extra codes. Modifier -59, on the other hand, is the "modifier of last resort" and shows that the two procedures were totally separate and unrelated. Modifier -59 overrides all NCCI Edits that have a "1" indicator, meaning that a modifier can bypass the edit.
 
One major difference between  modifiers -51 and -59: Most
carriers will reduce your reimbursement if you use modifier -51, but  modifier -59 will override any automatic cuts.
 
You should usually use modifier  -51 when you have multiple surgeries on the same site, says consultant Laureen Jandroep with A+ Medical Management & Education in Absecon, N.J. "Think of it as a volume discount," she says. You especially use modifier -51 if the multiple surgeries shared some work, such as prepping the patient and getting him into the operating room.
 
But if a procedure involves a separate site of the body, you should get paid separately, Jandroep adds. That's when you should add modifier -59 to ensure your payments won't be reduced. "You should really only use it if there's no other modifier to tell the story," she says.
 
"If a sizable portion of the work of the second procedure was done by the first procedure and hence the amount of work to be done by the second procedure is reduced, then modifier -51 is appropriate," says consultant Ken Lobo with Lobo Solutions Inc. in Poway, Calif.