Wiki Modifier 51 vs 59

[hparra112e@gmail.com]

Can someone explain to me when I would use a -59 mod and a -51 mod if there are multiple procedures?

Multiple Trigger Points done in the lower back:
cpt 20553, dx 724.2

Two tendon injections, one done in the elbow and the other in the knee:
cpt 20551, dx 844.1
cpt 20551, dx 841.2

The current biller is putting a -51 on the 20553 and a -59 on each of the 20551. Is this correct?

Thanks,
Heather

 

[dwaldman]

This revision helps to clarify that modifier -51 has four applications, namely to identify:

? multiple medical procedures performed at the same session by the same provider;

? multiple, related operative procedures performed at the same session by the same provider;

? operative procedures performed in combination at the same session, by the same provider, whether through the same or another incision or involving the same or different anatomy; and

? a combination of medical and operative procedures performed at the same session by the same provider.


October 1999 page 11

Coding Consultation

Modifiers -51 and -59 (Q&A)

Question

Can both modifiers -51 and -59 be appended to the same code on the same claim? Should these modifiers ever be reported on the same claim form?

AMA Comment

Since modifier -59 is to be used only if no more descriptive modifier is available, and the use of the -59 modifier best explains the circumstances, it would not be appropriate to append the -51 and -59 modifier to the same code on the same claim. However, there may be circumstances in which the -59 modifier is used on one code and the -51 modifier is appended to a separate code on the same claim form.

______________________
Code 20551(column 1) has a CCI conflict with code 20553(column 2). A modifier is allowed to override this relationship.

The modifier 59 would be supportive for 20551 x 2 since they were at separate anatomical sites. I provided some past information from AMA CPT Assistant, regarding the 2 modifiers. In a facility setting, 20553 & 20551 has a very similar reimbursement, in a non-facility setting CPT 20553 has the higher RVU, typically the primary procedure would not have the modifier 51. And in the AMA CPT Assistant article they state with the same code same claim you would not use both 59 51