Modifer -51

[karie]

We are having a discussion in our local chapter about modifier 51. Some say it can be used with a 3-lead (93042), as a second procedure of course, however, I don't think -51 can be used with 93042. Anyone else have an opinion? And if so, is there documentation to back it up?

 

[MLS2]

I don't see anything that states that a 51 modifier should be appended. I checked Ingenix Encoder.

 

[pamtienter]

The modifier was originally used to indicate which codes took a multiple procedure reduction. Now, most payers allow the modifier but don't do anything with it because they follow the multiple procedure indicators on the CMS Physician Fee Schedule to determine which codes get reduced. On the MPFS, 93042 has a multiple procedure indicator of "0" which means multiple procedure reduction does not apply, so the 51 modifier is not appropriate on this code.

 

[karie]

Thanks so much for that information!