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Billing Modifier 59 with 51

  1. #1
    Default Billing Modifier 59 with 51
    Medical Coding Books
    I have noticed a few of our providers have been billing procedures with both modifier 59 and 51 on the same CPT. I have always thought this to be incorrect, however, my supervisor said this is the right way to bill. I see 59 as a separate/distinct procedure unrelated to the original procedure, while 51 is stating that we are doing additional work to the primary. Why would billing them together be correct? In my research, I have found other examples of other procedures billed, also with both 59 and 51 together.

    Example of one of our claims:
    50715-LT
    58350-51
    58661-59/51
    44005-59/51 (This is already listed as a separate procedure)?

    Can any one shed some light on this for me?

    Thanks!

    Heather

  2. #2
    Location
    Long Island/New York
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    1,271
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    Can't do both

  3. #3
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Yes you can bill both if the scenario calls for it , the 59 states the procedure is distinct and separate from the other procedure and the 51 states that they were both performed at the same session for discounting. Althought I rarely if ever use both together there is nothing wrong with doing so.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default Separate issue
    In your example, 44005 should not be billed at all. It is a component of both codes 50715 & 58661. 44005 is not billable using any modifier when you are billing the other two codes. I am using the validation tool on customcoder.net which I have a subscription to via my job. I highly recommend this if you can get a subscription to it. It answers a lot of these questions and they also have a forum.
    Tina Hall, CPC
    Medical Coder I

  5. #5
    Location
    Capital Coders, Columbia, SC
    Posts
    145
    Default
    51-59 It's one or the other. Not both. By appending a modifier 59 to indicate that a procedure is distinct or separate from another which is being reported (on the sasme day), you are indicating that there are multiple procedures. There is no need to indicate it twice.

  6. #6
    Default
    Quote Originally Posted by halebill View Post
    51-59 It's one or the other. Not both. By appending a modifier 59 to indicate that a procedure is distinct or separate from another which is being reported (on the sasme day), you are indicating that there are multiple procedures. There is no need to indicate it twice.
    This is what I thought, but as I research it, I see it more often. I personally can't get my head around it.

  7. #7
    Default
    Quote Originally Posted by mitchellde View Post
    Yes you can bill both if the scenario calls for it , the 59 states the procedure is distinct and separate from the other procedure and the 51 states that they were both performed at the same session for discounting. Althought I rarely if ever use both together there is nothing wrong with doing so.
    Thank you. I guess where my confusion started was, I see 51 as "additional procedure to the primary procedure". Whereas 59 says Distinct and separate. How can it be distinct and separate, while saying its multiple or additional to the primary? Its kind of an oxy moran...

    Thank you for your help...from what I have been seeing, I guess I just need to accept it

  8. #8
    Location
    Columbia, MO
    Posts
    12,531
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    I think it may have to do with thinking the second procedure has some relationship to the first one. Just look at it as two procedures and nothing else. Then if the second procedure is ordinarily thought of as a component of the first procedure or is mutually exclusive, then the 59 might apply. the fact that both were performed at the same setting may indicate the need for the 51. I agree you really do not need it when you have the 59 present but like you I know several that use both together. There is nothing wrong with that it just seems a little unnecessary.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Location
    Everett, WA
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    886
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    Deb,
    I can't answer your wonderful helpful replies right now as my mailbox is overloaded and there's no way right now I can delete any of this valuable information that's been furnished. So, thank you for the information on the injections. That's exactly what I've been waiting for! Terrific breakthru in this process of stagnation....Hallelujah (smiles) Thank you so much!!!! Suzanne

  10. #10
    Location
    Columbia, MO
    Posts
    12,531
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    No problem but you did make me smile! Thank You.

    Debra A. Mitchell, MSPH, CPC-H

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