Help - 51 or 59 modifier

Rip

Networker
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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.)
 

Lujanwj

Guru
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-51 indicates that there were multiple procedures. -59 is to unbundle a procedure from another, stating that one had nothing to do with the other (to simplify). None of those codes are bundled so you would us -51(if payer even requires). However, per the NCCI Policy Manual (not edits) you might have an issue with 30520 and 30140. Payer might say that 30140 is incidental to the more extensive procedure 30520 so be ready for that.

I strongly suggest pulling the NCCI Policy manual and giving it a ready. It will clarify the usage of some of the most commonly used modifiers.

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/NCCI_Policy_Manual.zip
 
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