Wiki Billing Botox with Lesion Excision

[camillev23]

Hello,
I am trying to figure out how to bill botox (for chronic migraine) with an eyelid lesion excision. Which modifier do I use to indicate two separate procedures done on the same day? I'm uncertain if I should be using -51 or -59. Thank you!!

 

[SharonCollachi]

Modifier 51 or 59? How to know which to bill?

There are two modifiers commonly used in surgical specialties when billing two or more procedures at the same encounter. Appending the correct modifier increases the likelihood that the claim will be paid the first time, correctly.

Modifier 51 indicates that a second procedure was performed, and it is not a component code of the first procedure. There is no procedure-to-procedure bundling edit. Medicare contractors do not require modifier 51 on claims. Modifier 51 is not used on add-on codes, which are indicated by a plus sign before the code in the CPT® book.

Modifier 59 is used on a second procedure to indicate that although there is a procedure-to-procedure bundling edit for the second code with the first service, the second procedure meets the criteria of a distinct procedural service. For lesions, for example, this most often means the second procedure was done on a different lesion than the first.

 

[fwnewbie]

These are two different procedures done for two different diagnoses. Do you really need a modifier?