Pediatric Coding Alert

Question: Do I have to use modifier -51 every time I code a visit in which the pediatrician performs multiple procedures?

Hawaii Subscriber

Answer: No. There is a complete list of modifier -51 (Multiple procedures) exempt codes in Appendix E of CPT 2004. 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.

These modifier -51 exempt codes are also recognizable within the code listings of CPT; just look for a "circle with a slash" symbol to the left of the code. Get to know them before filing modifier -51 claims to prevent red tape and increase your practice's productivity.

For example, CPT designed the conscious sedation codes 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) and 99142 (... oral, rectal, and/or intranasal) to report a service provided by the same pediatrician who performs the primary procedure.

Both of these codes are modifier -51 exempt, so when the pediatrician performs the sedation, coders should report these codes without a modifier in addition to the other procedures.

-- Information for Reader Question and You Be the Expert provided by Richard H. Tuck, MD, FAAP, medical director of Quality Care Partners in Zanesville, Ohio.