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Modifier 51 vs 59 in E.D.

  1. #1
    Default Modifier 51 vs 59 in E.D.
    Medical Coding Books
    I just had the discussion with my supervisor, when a multitude of procedures are done in e.d./ i.e. chest tube insertion, blood transfusion, central line placed, intubation etc. what is the correct modifier assignment? I was wondering if anyone can tell me the difference between the reimbursement on a 51 to a 59? Just trying to be correct here. I tried to put in a -51 and it got kicked out, however not sure if that is what should have been used instead of -59. (-51 is not on hospital approved list)

    Anyone that can help me is appreciated...
    Pat A. Trautner, CCS/CPC/CEDC/CHONC

  2. Default
    Hello,
    The intubation and blood transfusion done in ED is billable for the same date of service. A 51 modifier may be appended for the intubation if rules go with that. A 59 modifier should not be given to any ED procedure is the forthcoming rule.

  3. #3
    Default
    A lot of Medicare contractors do not want you to apply modifier 51, as they will apply it internally if it's needed. If your billing multiple procedures that are bundled, you would use modifier 59 to unbundle. Check the CCI edits before billing to see if your procedures are bundled and if it's appropriate to unbundle.

  4. #4
    Default
    if the ER provider documented time spent with this patient, then critical care codes may be used....check guidelines for coding procedures and critical care

    Quote Originally Posted by ptrautner View Post
    I just had the discussion with my supervisor, when a multitude of procedures are done in e.d./ i.e. chest tube insertion, blood transfusion, central line placed, intubation etc. what is the correct modifier assignment? I was wondering if anyone can tell me the difference between the reimbursement on a 51 to a 59? Just trying to be correct here. I tried to put in a -51 and it got kicked out, however not sure if that is what should have been used instead of -59. (-51 is not on hospital approved list)

    Anyone that can help me is appreciated...
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

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