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Using Modifier 59 on multiple procedures

  1. Default Using Modifier 59 on multiple procedures
    Medical Coding Books
    I work for a Family Practice Clinic and we are having some questions regarding how to best get paid for multiple procedures our Docs perform in the office. An example would be that they excise a lesion and cryo an actinic keratosis at the same visit. Those would be like a 11400 and a 17000 both billed. Right now we attach a 25 modifier on the E/M code and attach a 59 to one of the procedures. But some people think we should attach the 59 to the code with the highest RVU and others say attach it to the lowest RVU. Truthfully, I am not even sure 59 is the right modifier to use let alone which code it should be attached too! Any help would be much appreciated, family practice docs don't make tons of money so we have to make sure we are getting paid as much as possible for each visit!

  2. Default
    You would not use a modifier 59 on any of the codes, you would use a modifier 51, since the codes are not bundled together. This would allow you to use the higher RVU amount: therfore, the 51 would/could on the lower RVU code....Hope this helps or atleast gives you a direction...

  3. Default
    I was under the assumption that 51 only applied when you did multiple procedures on the same area not if you did one excision on their arm and one on their face? Is that not right? And if we use a 51 they only pay at 50% vs paying at 100% if we use a 59.

  4. #4
    Columbia, MO
    The 51 indicates that this procedure is performed in the same session as the other procedure. The 59 indicates a procedure that would be bundled can be unbundled due to separate site, separate incision, both modifers will make the lesser procedure discount. The discounting will occure as you do not repeat the preop for each procedure so it is carved out of the second and subsequent procedures listed.

    Debra A. Mitchell, MSPH, CPC-H

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