Wiki Modifier 51 vs 59 - multiple surgeries

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Modifier 51 vs 59 - multiple surgeries

Modifier 51 Multiple procedures indicates provider furnished more than one (non-E/M) procedure during the same session. never append modifier 51 to designated add-on codes (any code listed with a “+”) or to modifier 51 exempt codes (identified in CPT by a “circle with a slash” next to the code)
Many payers, including Medicare, use software that negates the need to append modifier 51, under any circumstances. Check with your payer for its guidelines.
For those payers that require modifier 51, append it only to the “lesser valued” procedure codes. Never append modifier 51 to the highest-valued service billed on the claim.
Per CPT® Appendix A (Modifiers), “Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.” Such circumstances may include a documented:
• different session
• different procedure or surgery
• different site or organ system
• separate incision/excision
• separate lesion
CPT® and CMS guidelines agree that modifier 59 should be the “modifier of last resort.” As CPT® Appendix A explains, “Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.”

dawn1170

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Can someone explain to me when I would use a -59 mod and a -51 mod if there are multiple surgeries for example:

L/S cystectomy and H/S D&C (51 or 59)
or
58558 and 57065 (51or 59)

or please give me other examples!!

Any assistance is appreciated,

Dawn
 

dmaec

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If I coded two 36556 I would code it like this:
36556
36556.51
or
36556
36556.59 (depending on what carrier, because some do NOT like the .51)
But, why are you coding two insertions of Non-Tunneled Centrally Inserted Central Venous Catheters anyway? Just curious...
 

dmaec

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I see.... well, again - in my opinion it would be either:
36556
36556.51
or
36556
36556.59
I've never used a .59.51 together - I'm going to look into that usage a bit more tomorrow...
 
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San Diego
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Hi,

I see the (-51) modifier as an idicator to payors that multiple procedures were done during one operative session. By indicating which of the multiple procedures is "primary", I facilitate issuance of reimbursement. As you know, many payors allow for 100% of allowable for only the primary procedure & drop payment for subsequent procedures to 75%, 50% or 25%.

Modifier (-59) is more of a "bundling/unbundling" modifier. It is typically used to indicate that procedures normally considered "components" of one another and therefore not separately reimbursable, are in certain cases to be looked at "individually". The CCI Edits is utilized to determine which cpt codes are considered "bundled". I don't know of any other application in which this modifier should be utilized with the exception of "duplicate" procedures, as mentioned in a prior post.

I hope this info helps & Good Luck!
 

smcbroom

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Also remember that according to the CPT book, 59 modifier is an ASC approved modifier and not the 51 so if you are coding for an ASC which it sounds like you are not then take the 59 into consideration, but there are a few carriers such as Nevada Medicaid that like us to use the 51 modifier for multiple procedures. Just some more info for your thoughts!
 

erikau

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Also remember that according to the CPT book, 59 modifier is an ASC approved modifier and not the 51 so if you are coding for an ASC which it sounds like you are not then take the 59 into consideration, but there are a few carriers such as Nevada Medicaid that like us to use the 51 modifier for multiple procedures. Just some more info for your thoughts!
If you're doing multiple procedures, do you necessarily have to use modifier 51 since it's used as an "information only" modifier.
 
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4,466
Location
Milwaukee WI
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What about Mod 76

Don't know the specifics of the scenario involved ... but what about mod -76 - repeat procedure.

F Tessa Bartels, CPC, CPC-E/M
 

prem_ponnuru

Networker
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need 59?

Hi Mary,

I have a question do we need to append 59 mod for 28285 -TA and 28285 -59-T1. or any other same service u say.

TA and T1 or LT and RT not sufficient?

Prem.
 

mgord

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Columbia
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Today during a reimbursement meeting at our wound care clinic, we were told both by the reimbursement director and an office mgr that it didnt seem to matter if you used the -51 or the -59 that they both had reduction in reimbursement. I def dont agree that it doesnt matter which one you use, I understand the reasons why you would choose one over the other. But has anyone noticed the multiple surgery cut down being applied to codes billed with the -59??
 
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Do you have two pre- and post-op periods?

Remember that your reimbursement for any procedure includes the pre- and post-op care associated with that procedure. So ... Yes, you will get a multiple surgery adjustment even if you use a -59 modifier. Because the pre- and post-op care is rolled into one.

F Tessa Bartels, CPC, CEMC
 

rigdon72

Contributor
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Denver
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Don't know the specifics of the scenario involved ... but what about mod -76 - repeat procedure.

F Tessa Bartels, CPC, CPC-E/M
=========
I would not agree with -76 because it is a different site - not repeating the same procedure at the same site.
 

mamacase1

Expert
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If a doctor does an EGD and also does a Colonoscopy on the same day in his office would you use and 51 or 59 modifier on the EGD?:confused:
 

mitchellde

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You would only need the 51 (keeping in mind some carriers do not want/need this modifer any longer), the 59 is not needed. You do not need to worry about bundleing of these two procedures. Definition of the procedures is enough to say distinct ans separate. For you cannot use the colonoscopic approach to inspect the esophagus!
 

ahmed

Banned
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Modifier 59 is used to indicate that two procedures are distinct procedures which are performed at different times and/or locations whereas modifier 51 is used when same physician performes more than two procedure at the same time
 
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