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Which modifier do I use 51 or 59?

Pt surgery:
Uvulopalatopharyngoplasty: 42145
Septoplasty: 30520-59
Bilateral Submucous Resection Turbinate 30140-50-59
Adenoidectomy over 12y/o 42831-22-59
(op note states complicated by extent size of adenoids and possibility of
a maligant neoplasm. Difficulty increased 100%. Adenoidectomy typiciall
takes 15-20 mins this required 60 minutes to adequately excise adenoid
neoplasm and enlargement.)
 

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