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To use Mod. 51 or not to use....

  1. #1
    Question To use Mod. 51 or not to use....
    Medical Coding Books
    Please help! I recently heard that Medicare will not allow use of Mod. 51 anymore and I've heard some coders state that they don't even append it to CPT codes at all. I bill for general surgeons so we do a lot of "multiple procedures" and I am worried that I have been billing incorrectly because I have been using the 51 Modifier. Can anyone point me to the area on the CMS website that discusses this? Please help!
    Chrissy, CPC

  2. Default modifier 51
    If you go to the National Government Services website and go into Medicare University it talks about it. I also found it on the US Department of Labor website. The following post is from the ACS website:

    Latest Developments
    As of April 19, 2009: Pricing updates to Multiple Surgeries and Maximum Units

    Multiple Surgeries - Bills submitted with multiple surgical procedures no longer require the submission of modifier 51. The "primary" surgery will be priced at the lower of (a) the actual charge, or (b) the fee schedule amount for the procedure. Other surgical procedures performed on the same day will be priced at the lower of (a) the actual charge, or (b) the fee schedule amount for the procedure reduced by 50%.

    Maximum Units - The maximum number of units billed will be paid based on the allowed number of units per day for the procedure. Billed units, which exceed the allowed number of units on file, will be reduced and paid based on the maximum number of units applicable for the submitted dates of services

    Since it just went into effect, the worst that can happen is your claims deny and then you could just go back and correct them.

    Hope this helps,
    Jama Vestergaard

  3. #3
    Thank you!!
    Chrissy, CPC

  4. #4
    I still use modifier 51 for all payers, except for Medicare. If you do not append the modifer to other payers, we have found that on some scenarios they are not paying the primary code at 100%. Instead, they reimburse the second or third procedure code 100% and take a multiple procedure reduction on the primary code. If you append the 51, at least you know which codes are subject to multiple procedure reductions. Hope this helps!


  5. #5
    Greeley, Colorado
    We still use it. What I find interesting is that one of the RAC issues they may be looking at is modifier -51. The information I have read seems to indicate that they will audit for use and non use. If you don't use it, it could cause an overpayment, and if you do it's an underpayment issue. Kind of puts us between a rock and a hard place.
    Lisa Bledsoe, CPC, CPMA

  6. #6
    Default modifiers 51
    We were just on a Highmark Webinar are they said we should be using 51.

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