Wiki Mod 51 or 59?

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GAcoder

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I get the use of 51 and 59 confused sometimes. What modifier would you
use for following scenario? Thanks for help
99214-25
96374
96375
96372-? 51 or 59?
96372-59
 
M 51 or 59

I agree with you.
The guidelines states, If a significant separately identifiable office or other outpatient Evaluation and Management service is performed the appropriate E/M service code should be reported using modifier 25 in addition to the code (eg 96372). Same day E/M service a different diagnosis is not reqired.

The guideline also states, "when administering multiple infusions, injections or combination only one initial service code should be reported for a given date etc....For both physician and facility reporting, only one initial service code ( e.g, 96365) or in your case 96372 should be reported unless the protocol or patient condition requires 2 separate IV sites must be used. The difference in time and effort in providing second I V access is also reported using the initial service code with modifier 59.

Hope this is helpful
Mary Wilson
 
Hi,

I too agree with msmary. CPT 96372 should be appended with modifier 59 to distinguish from other CPTs. Moreover modifier 59 will get preference over modifier 51 in order to bypass the CCI edit.
 
CPT Assistant
Year: 2014
Issue: March
Pages: 11
Title: Coding Brief: Pulmonary Diagnostic
Testing and Therapies, Codes 94060, 94400, 94770, 94640

CPT code 94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device), describes the use of equipment for nebulization of medication, which may include bronchodilators, mucolytics, antibiotics, and other medications. Nebulization of medication may be done for diagnostic or therapeutic purposes, and can be done in the inpatient or outpatient setting. Code 94640 should not be reported when the nebulization is performed for therapeutic purposes. Modifier 76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, should be appended to code 94640 when reporting more than one inhalation treatment performed on the same date of service.
 
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