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Modifier 51 vs. Modifier 59

  1. #1
    Overland Park, KS
    Default Modifier 51 vs. Modifier 59
    Medical Coding Books
    A patient presents to the office for removal of three skin tags from his abdomen. During the same session, the physician also excised a benign lesion measuring 3.5 cm from the patient's nose.

    Would I report modifier 51 or modifier 59 in this case? Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  2. #2
    Columbia, MO
    you might need both. The 59 would be if one procedure is considered bundled with the other, the 51 is used to indicate the second and subsequent procedure in the same session.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    You would use modifier 51

  4. #4
    Overland Park, KS
    Thanks to both of you for the help!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  5. #5
    Greeley, Colorado
    Exclamation Modifier -59
    You would code 11200 and 11444-59. Modifier -59 is used to identify different sites (nose vs abd) and different lesions.
    Lisa Bledsoe, CPC, CPMA

  6. Red face
    first of all,

    know your carrier! While Medicare no longer requires the use of the 51 modifier, many commercial carriers still want to see it.

    definitely use the 59, 51 is only needed if your Carrier requires it.

    Caprice, CPC

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