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.”