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Thread: Modifier 51

  1. #1

    Default Modifier 51

    AAPC: Back to School

    I have a Dermatologist that excises lesions (11602), then he does the intermediate laceration repair (12032).... In CMS, Medicare has a status indicator which tells their claims system that the 2nd procedure 12032 is multiple, and it pays accordingly. Other payers require the 51 in order to process claim.....

    Do we need the mod-51?
    Marilyn CPC, CPC-H, CEMC

  2. #2
    Join Date
    Apr 2007
    Glendale Arizona

    Thumbs up 51 mod usage

    Hi there, I work for an orth clinic and we do that stuff all the time! The most expensive code is prime and the following code/codes are coded with a -51 modifier. Unless procedures are performed in different areas like the finger and the forearm you usually never have more than one "primary procedure" to be billed. In our case the patient usually presents with a wound and we would perform a debridement 11043 and then a closure 12001-51.In your case I would follow the same rules as long as the two procedures are not bunddled...Hope this helps.

    Karen Hayen, CPC
    Karen Hayen, CPC

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