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Modifier -51/-59 Dilemma AGAIN!

  1. Unhappy Modifier -51/-59 Dilemma AGAIN!
    Medical Coding Books
    Re: Integumentary System - when coding repairs of wounds and the anatomic groups are different, would the second code, which would be a different anatomic group than the first, take a -59 modifier or a - 51? The CPT book states that if the classifications are different, the second code would take a -51 modifier. However, it doesn't say anything if the anatomic groups are different. H E L P P P P P P P!

    Sheryl Kinne

  2. Default
    Best bet... check the guidelines with your payor. Some of them REQUIRE 59 no matter the case.

  3. Default
    I would check the CPT codes in the CCI edits (for those insurance companies that follow Medicare). If the CPT codes are not bundled, then I would report them with a 51 modifier to show multiple procedures. If it shows that they are bundled but has a (1) next to them, showing that they can be unbundled with different anatomical areas, then I would report the CPT codes with a 59 modifier.

  4. #4
    Milwaukee WI
    Default It depends ...
    CPT says to "Sum lengths of repairs for each group of anatomic sites" for the repair codes.
    For Modifier 59 CPT specifies "... different site...separate incision..."

    So, as an example:
    Patient arrives with multiple wounds w/ repairs as follows:
    Left upper arm wound 2.5 cm - simple repair
    Left thigh wound 3.2 cm - simple repair
    Left thigh wound 1.8 cm - intermediate repair

    You would add together the lengths of 1st and 2d wounds to code CPT 12002
    You would separately code 3d wound - 12031[59]

    I'd use the 59 modifier because it is a "separate incision"

    Hope that helps.
    Tessa Bartels CPC

  5. #5
    Chicago South East Illinois Chapter
    Thumbs up Modifier -51 versus -59 Dilemma
    I agree with Tessa

    The rule of thumb is. If you are working in the same site doing multiple
    procedures before closing then you would need to use -51 on the second or third cpt code(s). If that incision is closed and you move to a different anatomic site and make a "separate" incision you would use -59 on the first cpt code. Say for instance multiple procedures are also done in that separate incision/site as well you would append -51/59 to the second or third
    cpt code(s).

    Dbryant, M.A.,CPC

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