AAPC - Back to school
Results 1 to 2 of 2

Thread: Pain Mgmt--Modifier 51 or 59

  1. #1
    Join Date
    Apr 2007
    Jacksonville River City

    Question Pain Mgmt--Modifier 51 or 59

    AAPC: Back to School
    Which way would be the correct way to bill the following procedures as far as modifiers are concerned? There is controversy in our office as to which is correct.

    64490 (723.1 & 729.2)
    64450-51 (729.2)


    64490 (723.1 & 729.2)
    64450-59 (729.2)

  2. #2
    Join Date
    Apr 2007


    No bundling issue exists with codes: 64490 and 64450. You could bill with the 51 modifier. Typically the rationale for using the 59, is when according to the NCCI guidelines, the column two code is considered bundled. You add the 59 to state that it meets the criteria for separate payment after reviewing the NCCI policy manual. There are other circumstances with certain commercial carriers that would need the 59 instead of the 51 on certain code combinations.


    "For the NCCI its primary purpose is to indicate that two or more procedures are performed at different anatomic sites or different patient encounters. It should only be used if no other modifier more appropriately describes the relationships of the two or more procedure codes."

    The CPT Manual defines modifier 59 as follows:
    "Modifier 59: Distinct Procedural Service: Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter,different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used."

Similar Threads

  1. E/M with pain mgmt procedure
    By Melissa1987 in forum E/M
    Replies: 2
    Last Post: 03-29-2013, 07:06 AM
  2. UA screening - pain mgmt
    By ALALA in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 10-02-2012, 11:06 AM
  3. Pain Mgmt Coding
    By Deb2009 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 08-13-2012, 02:14 PM
  4. Help with Pain Mgmt Code Please
    By ojustus in forum Outpatient Facilities
    Replies: 0
    Last Post: 07-30-2010, 01:49 PM
  5. modifier question for pain mgmt
    By elisaarb in forum Anesthesia
    Replies: 3
    Last Post: 06-24-2010, 08:00 AM

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?


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.