Wiki Modifer 51 - Should I use

[slimmagnum]

Good Morning
Should I use a modifier 51 when billing a colonoscopy (45380) with a banding (46221) ? I was under the impression these were separate procedures and were not bundled together. How about if I'm billing another colonoscopy procedure such as 45385 with 46221. Would it require a modifier
Thank you for your response

 

[emcee101]

Unless billing Medicare, you ALWAYS want to use modifier 51 when billing for multiple procedures, except when using "add-on", E/M, and PMR codes. You should sequence the code with the highest RVU value first (45380 or 45385 in your example) and use 51 on all other procedures billed thereafter.

Since secondary procedures ale almost always reduced in payment due to the multiple procedures payment reduction (MPPR), this will stop the insurance company you are billing from flipping your code order (they say they don't do it, but they do...) and paying you 100% of a lesser RVU code and the reduced rate for the higher RVU code. This is not needed with Medicare because they will automatically order your codes in correct RVU order.

It sounds like you may have modifier 51 mixed up with modifier 59 and the X{EPSU} series of modifiers, which refer to different scenarios of bundling and unbundling CPT codes.