Modifier 51

DFUGET

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New Orleans, LA
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I was wondering does anyone use modifier 51 for gastro? I have never used modifier 51 when coding an upper and a lower. I have always used modifier 59 or an X modifier. I have a coder that keeps using 51 on the egd when billed with a colon. Does anyone else use 51 instead of 59?
 

ht3dn1k91

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I was wondering does anyone use modifier 51 for gastro? I have never used modifier 51 when coding an upper and a lower. I have always used modifier 59 or an X modifier. I have a coder that keeps using 51 on the egd when billed with a colon. Does anyone else use 51 instead of 59?

I am actually having this same issue. I am looking for more info also on 51, because apparently we "over use" 59.
 

dkissel

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Flint, MI
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I've never had to use either modifier. All payers I bill (I'm in Michigan, WPS is our MAC) pay a colon and an EGD without submitting modifier 59 or 51 on the same day. WPS Medicare returns claims with the 51 on the EGD.
 

RDK720

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Hi. When it comes to GI coding, you typically use 51 modifier when doing an Upper and Lower Endo. You would use 59 modifier when billing two Upper or two lower Endo, etc.
 

bbeatty

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We no longer do doubles but when we did, we did not use a modifier 51. We use a 59 modifier for two uppers or two lower procedures but nothing for an upper and lower together.
 

DFUGET

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New Orleans, LA
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My MAC does not require us to put the 51 on the second procedure. They add it automatically. What the coder is doing is adding 5951 on one line. I don't think it is necessary to use both modifiers.
 

Ritika

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Hi, we do not use 51/59 modifier while coding both lower and upper endo as both of the procedure are different and their reason would be different as well. we bill them seperately.
 
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