Wiki Modifier 59, 51, or both?

[jhanmer83]

I have this encounter where the provider performed 3 procedures. When I looked up the NCCI relationship, none exists, however some are telling me to use modifier 59 on code 11981 and 51 on 56605. Can I get some other opinions on how to code this? The patient is self-pay, but will likely end up with Medicaid. I don't know if NC Medicaid requires the 51 modifier or if they have it built into their system to recognize multiple procedures. Below are the procedures. How would you code it?

11981 - Nexplanon insertion - wRVU 1.14 - price $274
58100 - Endometrial biopsy - wRVU 1.21 - price $367
56605 - Vulvar biopsy - wRVU 1.10 - price $1018

 

[RaveenaS]

No MCD NCCI edits so I wouldn’t put any modifiers. The only time I use modified 51 is if I know for sure Medicaid will deny or they’ve made it clear that multiple procedures need it because the system they have in place will not auto adjust. Most payers have their system in place though, so unless you know for sure they don’t, I would not add 51. 59 is used when needing to unbundle C1/C2 so none of these codes hit against each other so you should be good to bill as is.