Primary Care Coding Alert

Test your modifier knowledge. Determine how you would append this situation before looking at the box below for the answer. If your practice were presented with the following scenarios, would you append modifier -51 or modifier -59? Case #1: Patient presents with a laceration to the shoulder and a laceration to the face from falling down. The physician repairs and closes the wounds (12001 and 12011). Would you append modifier -51 or -59? Case #2: A patient presents with arthroarthritis in the shoulder and the knee. The FP gives the patient a prednisone injection (20610) in each place. How would you code the procedures? Case #3: The FP biopsies an actinic keratosis lesion (11100) and excises a separate actinic keratosis lesion (11400) during the same session. How would you code the procedures? Case #4: A patient presents to the office with chest pain. The FP performs an EKG (93000), which is found to be normal, so he gives the patient a stress test (93015). How would you code the procedures? Case #5: The FP excises a lesion of 1.0 cm on the patient's right arm (11401) and another lesion of 1.0 cm on the patient's left arm (11401). How would you code the procedures?         Coding #1: Modifier -51. Append modifier -51 to 12001, and bill 12011 separately. Even though the wounds were caused by the same accident, the physician treated each as a separate injury. The modifier -51 tells the carrier that this is a multiple surgical procedure. Because these lacerations are in two separately identified anatomic sites, each laceration was separately reported. Coding #2: Modifier -59. To show that these are two separate injections and that you are not double-billing for one, use modifier -59. Report 20610, 20610-59. In the past, coders needed modifiers -51 and -59 for trigger point injections, but CPT 2002 revised and added new trigger point codes that no longer require modifiers. For more on this, see the article "Shoot for Dollars With Trigger Point Coding" in the September 2002 issue of Family Practice Coding Alert. Coding #3: Modifier -51 and -59. Attach modifiers -51 and -59 to 11100 to indicate that both services were done at the same session and that the biopsy was from a different actinic keratosis than the one that was excised.

Note that if the FP biopsies and subsequently removes the same actinic keratosis lesion during the same operative session, you cannot be paid for both because even modifier -59 does not allow those procedures to be unbundled. You would, in that case, report only the code for the removal of the lesion, i.e., 11400. Coding #4: Modifier -59. Append modifier -59 to the 93000. Because CCI bundles [...]