Results 1 to 10 of 10

Modifiers for multiple procedures

  1. Default Modifiers for multiple procedures
    Medical Coding Books
    I the doctor performs a colonoscopy with a cold biopsy and an EGD with a biopsy, would this be coded correctly with a 51 modifier on the EGD?
    44380 , 43239-51

  2. #2
    Location
    Atlanta Perimeter Georgia Chapter
    Posts
    7
    Default bwalters
    Quote Originally Posted by JETGEN View Post
    I the doctor performs a colonoscopy with a cold biopsy and an EGD with a biopsy, would this be coded correctly with a 51 modifier on the EGD?
    44380 , 43239-51
    No Modifer 51

  3. Default
    No 51 on 43239, because it is in another family?

  4. #4
    Default
    I always use a 51, just for good measure, but the information that seems to be coming out now is that the 51 is becoming more obsolete, most payers are not working with it anymore. I bill gastro for both physicians and an ASC, and I always 51 modify it, but it isn't necessary. You can get your claims paid without the 51. The only exception to this that I have found information on is the EGD with dilation, 43450, this one requires a 51 when it is billed with a straight EGD. Here is some info I thought you'd find helpful on the 51:

    • Used to indicate that the physician performed more
    than one procedure on the same patient during the
    same session.
    • When reporting a multiple surgical session, report
    the major surgery without the 51 modifier and
    append each additional procedure with a 51
    modifier. Payment for this is based on 100% of
    Medicare allowable for the major and 50% of
    Medicare allowable for each additional. Please note
    that some procedures are not subject to the
    multiple surgery reduction guidelines.

    It's not absolutely necessary, but it's not going to hurt you if you use it. So it's kind of up to you. If anyone else has any different info, please share, because this is what I have researched and read in the Coding Edge and other coding sources. :0)

  5. #5
    Default
    I would use modifier 59.

  6. #6
    Location
    Columbia, MO
    Posts
    12,844
    Default
    Quote Originally Posted by kredmond803@bellsouth.net View Post
    I would use modifier 59.
    No need for a 59. The two procedures are already distinct and separate by procedure definition. Under no circumstance would you ever perform one of these procedures via the same route. in other words you would never examine the esophagus with a colonoscopic approach. when the procedures are distinct by definition, then you would not use a 59.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Default
    Quote Originally Posted by mitchellde View Post
    No need for a 59. The two procedures are already distinct and separate by procedure definition. Under no circumstance would you ever perform one of these procedures via the same route. in other words you would never examine the esophagus with a colonoscopic approach. when the procedures are distinct by definition, then you would not use a 59.
    Which modifier would you use? Also, we have noticed that a lot of carriers do not recognize modifier 51.

  8. #8
    Location
    Columbia, MO
    Posts
    12,844
    Default
    If they do not recognize the 51 then no modifier is needed. Just because you put two procedure codes on a claim does not mean you must use a modifier.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Default
    I agree wholeheartedly with Debra. Like I stated in my prior comments, the 51 is becoming more obsolete, and is not a necessary modifier, and the 59 definitely doesn't work in this case. I'm glad you posted the above reasoning on that Debra, that's what I always say too, and I get arguments all around. The 59 is not applicable to procedures done via separate routes that are by nature distinct and separate already!

  10. #10
    Default
    Thank you for the clarification.

    I talked to some of my colleagues and they inform me that when we did not use a modifier, the claims were being denied as duplicates. Modifier 51 was not recognized and modifier 59 had to be used in order for our claims to be processed.

    Again, thank you for the clarification.
    Last edited by KRED; 12-06-2010 at 10:46 AM.

Similar Threads

  1. Modifiers with multiple specimens with multiple IHC stains
    By ColqPath in forum Pathology & Clinical Laboratory
    Replies: 10
    Last Post: 05-09-2014, 02:43 PM
  2. Coding Multiple Procedures on Multiple Digits
    By lora.a.cherry@gmail.com in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 01-02-2014, 07:43 PM
  3. Coding Multiple Procedures on Multiple Digits
    By lora.a.cherry@gmail.com in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 01-01-2014, 11:34 AM
  4. Unlisted Procedures and Modifiers
    By joanne71178 in forum Modifiers
    Replies: 0
    Last Post: 01-29-2013, 07:40 AM
  5. multiple procedures/modifiers
    By johnson.r.a in forum Modifiers
    Replies: 2
    Last Post: 03-29-2012, 02:47 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.