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Modifiers -51 and -59

  1. #1
    Question Modifiers -51 and -59
    Medical Coding Books
    As I am learning Cardiology and this is my 6th month in my first coding position, I am still a little frazzled on the usage of modifers -51 and -59. We have EncoderPro that helps us plug in our CPT's and dx but it ALWAYS wants me to use -51 when sometimes I feel I should be using -59. Is there anyone that can help me differentiate the two and when it is appropriate to use these modifiers in Cardiology Coding???

    I appreciate any help I can get!

    Brandy Edmondson, CPC

  2. #2
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    Quote Originally Posted by brandyleigh23@hotmail.com View Post
    As I am learning Cardiology and this is my 6th month in my first coding position, I am still a little frazzled on the usage of modifers -51 and -59. We have EncoderPro that helps us plug in our CPT's and dx but it ALWAYS wants me to use -51 when sometimes I feel I should be using -59. Is there anyone that can help me differentiate the two and when it is appropriate to use these modifiers in Cardiology Coding???

    I appreciate any help I can get!

    Brandy Edmondson, CPC
    51 is for when multiple (non-E/M) procedures are performed by the same provider at the same encounter. Honestly, I really don't see a need for 51 very often, but you might run across it in cardiology here and there. It usually only affects pricing for the codes that have the modifier, so don't put it on your most expensive (primary) procedure.

    Think of 59 as being kind of like the 25 modifier, but for procedures. When you have more than one procedure done at the same time, you use modifier 59 if: A) They're not usually performed during the same encounter (mutually exclusive), B) One is generally considered to be included in the other, but this time, it's on a different area of the body, or C) You're billing two labs that can be described by the same code, but are testing for different strains/species of the same organism. The code pairs that require a 59 modifier will almost always be somewhere on the NCCI edit tables, and they will have a status indicator of "1". Like the 51 modifier, 59 affects reimbursement; the key difference is, without adding a 59 modifier when it's needed, you absolutely will have a denial, and it does matter which code you put it on. You have to add the 59 modifier to the code you're trying to flag as "distinct" from the other procedures, so it will always go on the less extensive procedure (that would otherwise be bundled into something else). I hope that helped, and didn't make it more confusing!

  3. #3
    Thumbs up
    Thank you Brandi, that makes perfect sense! I have tried researching on my own and the Encoder is telling me one thing and the person that does our "Scrubber" is telling me another and I want to be SURE of what I am coding.

    There is alot of reading between the lines in coding. I work in the Cardiology office and code their hospital procedures. I get many caths and sometimes AFR's, Revascularizations, and Inverventions are done on the same day by the same provider. I have been trusting my gut to use -59 but like I said, the Encoder Program we have always tells me to use -51.

    Anyway, you were a GREAT help and I appreciate your response! Thanks again

    Brandy Edmondson, CPC

  4. #4
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    Everett, WA
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    I was having the same issue with Encoder Pro when attempting to use their claim scrubber. It kept prompting for the 51 modifier and my instinct told me it was not correct. Per test claim, I submitted a few claims with the 51 modifier and they were denied, so am learning to trust my own personal training more. We are correcting and will rebill. ---Suzanne E. Byrum CPC

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