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modifier 51 vs. 59 in asc

  1. #1
    Default modifier 51 vs. 59 in asc
    Medical Coding Books
    I would like to know which modifier 51 or 59 is approriate to use when billing for more than one procedure at an asc. For example 45380 colonoscopy and 43239 endoscopy on the same day. thank you.

  2. #2
    Default
    According to NCCI edits and also ASC coding guidelines along with the support of CPT, the modifier -59 should always be used on these codes. The -51 modifier would come in to play when you have several different procedures performed on the same date of service.

    About modifier 51
    Modifier 51 (multiple procedures) is used to inform payers that two or more procedures are being reported on the same day. A claim form (UB-92) that has modifier 51 appended to a CPT code(s) [COLOR="rgb(255, 140, 0)"]tells the payer to apply the multiple procedure payment formula [/COLOR]to the CPT code(s) linked to the modifier 51, assuming the payer accepts this modifier.

    I hope this helps you!
    Amy Pritchett,
    BSHA, CPC, CPMA, CPC-I, CDEO, CANPC, CEDC, CASCC, CRC, CMDP, CMPM, CCS, CMRS, C-AHI, ICDCT-CM, ICDCT-PCS
    2017-2018 Secretary of Local Mobile AAPC Chapter
    2015-2016 President of Local Mobile AAPC Chapter

  3. #3
    Default
    Thank you Amy. Very helpful.

    Kirsi Proctor, CPC

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