Wiki Modifier 51

[julie126]

Good morning,
Quick question. I work for an orthopedic office, and we perform a lot of injections. If a provider does multiple injections, should we bill a 51 or 59 modifier?
Example:
20610-rt
20605-51lt

Another coder in our office only appends Rt and Lt modifiers. Any recommendations? Thanks!

 

[NiteshlalKoyalkar]

Hi,
Modifier 51 Multiple procedures indicates that the same provider performed multiple procedures—other than E/M services—at the same session. You should list the most resource-intense (highest paying) procedure first, and append modifier 51 to the second and subsequent procedures.

Use modifier 51 to indicate:

Same procedure, different sites
Multiple operation(s), same operative session
Procedure performed multiple times

Most payers apply a “multiple procedure discount” with modifier 51. This refers to the practice of reducing the reimbursement for subsequent procedures because of shared resources when two or more procedures are performed together. CPT® Appendix E lists codes that are exempt from modifier 51.
Modifier 59 Distinct procedural service is used to indicate a:

Different session or encounter
Different procedure
Different site
Separate incision, excision, lesion, injury, or body part

Modifier 59 is frequently appended to those codes defined as “separate procedures” in CPT®. Designated separate procedures commonly are carried out as an integral component of a more extensive procedure. Only when a procedure or service designated as a separate procedure is carried out independently, and is considered to be unrelated or distinct, may it be reported separately.

 

[CodingKing]

Modifier 51 is just for multiple surgery pricing reduction. Most payers don't want the modifier 51 applied which is why the other person may have not been including it.
59 isn't always necessary either unless there is an NCCI edit. in your example there is no edit because the codes are for different kind of joints thus no mod 59 required.

 

[WendyJeann81]

I work in for an ortho office and we do not use modifier 51 ever.
For the example you gave, I would have coded it as follows:
Example:
20610-rt------20610-RT
20605-51lt----20605-XS-LT

Hope this helps