51 modifier

[TPeniston61]

I work in orthopedics. I'm sometimes confused about when to use modifier 51. It seems that some codes stand by themselves and don't require a modifier, and other combinations will require the 51 modifier. The NCCI edits don't trigger an edit with 51. How do I know when to use it or not?

 

[thomas7331]

I've been coding for about 20 years now and have not run into any payers that still require providers to use the 51 modifier. Payers that use claims systems which need the modifier for payment calculations will add it to provider claims automatically, so I think it's common practice among providers to simply not use this modifier any more. I'm not sure why CPT doesn't just delete this modifier as it seems to have become quite outdated and unnecessary.

But if you do need to use it, you would apply this to the second and any additional surgical procedure codes for your encounter, excluding add-on codes and codes not subject to multiple procedure reductions. In other words, among the codes subject to reductions, you would omit the modifier on the highest value code, and apply the 51 to all of the remaining codes. It can be time-consuming to determine this, so I'd recommend not taking the time to do it unless one of your payers requires it as it would add an unnecessary cost to your providers' practice.

 

[erjones147]

What Thomas said. I used to have to use a 51 for a special optometry procedure for Novitas Medicare, but we got a new machine that didn't use one of the codes, so good bye (and good riddance) to 51 for me

 

[carelitz]

Agree with the others. I have never added modifier 51 to a CPT code for multiple procedures. I can see on my Medicare payments that modifier 51 is added on their end and paid accordingly.


"Medicare doesn’t recommend reporting Modifier 51 on your claim; our processing system will append the modifier to the correct procedure code as appropriate."

https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144532&_adf.ctrl-state=86hvagjfk_33