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Modifier 51 help!!!!!!!

  1. #1
    Red face Modifier 51 help!!!!!!!
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    I need some help understanding when you can and can not use modifier 51?
    I have a doc who performed two injections, same pt, same day- different site... Can i report modifier 51?
    Thanks!

  2. #2
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    need little more information . what type of inections? Mod 51 is for multiple procedures.

  3. #3
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    Be sure to double check your code(s) are not modifier -51 exempt.
    Mjones7

  4. #4
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    Quote Originally Posted by mattrobin View Post
    I need some help understanding when you can and can not use modifier 51?
    I have a doc who performed two injections, same pt, same day- different site... Can i report modifier 51?
    Thanks!
    It does help to know the codes you are using such as a joint inject say right shoulder rt hip would be
    20610 rt
    20610 59 rt 51
    a therapeutic injection would be
    96372
    96372 59 51

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
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    If you are coding for bilateral injections to Medicare (ie both knees) you would code 20610-50 and increase the fee by 50%. If separate joints (knee, hip) 20610 w/dx for one joint and 20610-59 w/dx for the other joint.
    Lisa Bledsoe, CPC, CPMA

  6. #6
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    modifier 51 means you do not expect to collect 100% of the normal amount from the carrier. Bit if the carrier thinks that the multiple procedure(s) reduced the value of the services, that is when they will apply the reduction, and even if you do not apply the modifier, they will append it and they will pay 50% of their normal amount. In the case of the injections, normally the doctor's work effort was not reduced, so it probably would not apply. Bill the codes without the modifier, and if the carrier reduces the payment, write an appeal stating that the doctors' effort was not reduced and the reduction was unfair. (Before writing the appeal, make sure the doctor approves it!)
    jm
    Last edited by Jamesmmm; 01-12-2010 at 09:04 AM. Reason: addition/revision

  7. #7
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    Quote Originally Posted by setapart10102700@yahoo.com View Post
    modifier 51 means you do not expect to collect 100% of the normal amount from the carrier. Bit if the carrier thinks that the multiple procedure(s) reduced the value of the services, that is when they will apply the reduction, and even if you do not apply the modifier, they will append it and they will pay 50% of their normal amount. In the case of the injections, normally the doctor's work effort was not reduced, so it probably would not apply. Bill the codes without the modifier, and if the carrier reduces the payment, write an appeal stating that the doctors' effort was not reduced and the reduction was unfair. (Before writing the appeal, make sure the doctor approves it!)
    jm
    I'm sorry but I must disagree with this. Any time a physician performs two procedures on the same patient at the same time, the one with the lower RVU value should have a mod-51. The physician's workload is always reduced for the second procedure done during the same visit.
    Walker Bachman, CPC, CPPM

  8. #8
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    Walker is correct. The first procedure is paid at 100% because you had to perform all the prep the second procedure is reduced because they carve out the prep as it was already done. There is no way to appeal this. If your documentatation supports two different sessions on the same day for medical necessity then a modifier will allow the second procedure to not reduce.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
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    On the 2010 National Physician Fee Schedule Relative Value File from CMS, when you locate the procedure and you scroll over to the column that says "Multiple Procedure" and there is the number 2 there, does that mean that -51 applies or not? I'm a little confused here because reading the manual seems to imply that the number 2 means that you can apply -51, but some of the procedures have a number 2 in that column and it does not make sense that -51 would apply (i.e. 69210 for cerumen removal).
    Last edited by dballard2004; 01-12-2010 at 11:35 AM.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  10. #10
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    A number "2" in the multiple procedure column in the RBRVS means that the mod-51 rules apply.
    Walker Bachman, CPC, CPPM

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