Wiki Multiple procedure modifier 51

[cvand1972]

I'm wondering on which CPT code the 51 modifier should go on. NPFS states to rank the procedures based on fee schedule amounts but when you rank them and you are billing a CPT code with a 26 modifier showing that you are only billing for the Professional Component, do you base your ranking on the global CPT code for that service or the Professional Component part only.
I'm billing a LHC w/ Stent. These are the codes:

93510-26
93543
93545
93539
93540
93555-26
93556-26
92980

I think it should be based on the Professional Component if that is what I am billing, but I could be wrong.
If I'm right then I should be appending the 51 modifier to the 93510-26 and the 93543. But if I am wrong, I should be appending the modifier to the 92980 and the 93543.

 

[cvand1972]

I actually think I'm misunderstanding and what I should really be doing is appending the 51 modifier to the stent because the Cath is the main procedure. Oh dear.....maybe I'm thinking to much.

 

[sbicknell]

Mod -51 is not appropriate for a heart cath. You need to use -59 when a cath and stent are done on the same day

93510-26
93543
93545
93539
93540
93555-26-59
93556-26-59
92980-LD, LC or RC modifier to identify vessel

Possible Dx 414.01, 414.02, 414.04, V45.81

 

[cvand1972]

Oh. Good thing I asked. When I looked at the CMS NPFS it has a '2' in the multiple procedure indicator and went from there. Thanks for the info!!! Very much appreciated.