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Modifier 59 and 51

  1. #1
    Default Modifier 59 and 51
    Medical Coding Books
    I am trying to figure when its appropriate to add modifier 51 or modifier 59.

    Example- I have 2 codes, 25116 and 64721 and the DR would like to apply 59
    I disagree, Can someone please advise

    dx 354.0
    dx 727.05

  2. #2
    Baton Rouge
    Modifier 51 is appropriate in this case. Modifier 59 is generally used to bypass CCI edits when the services qualify. However, these 2 codes are not listed together in the edits, so no bundling issue. Claim should look like this:

    25116 dx 727.05
    64721-51 dx 354.0

    Hope this helps!

  3. #3
    Codes 25116 and 64721 are bundled per CCI edits. In this case it would be appropriate to add a modifier 59 to 64721. Modifier 59, Distinct Procedural Service, is intended to be used to indicate that a procedure or service is distinct or independent from other services or procedures performed on the same day. This modifier is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances.
    Laura Blandin, CPC, CHCA, CPMA

  4. #4
    Baton Rouge
    Laura, would you mind posting where you found this info? I checked before I posted, and just rechecked again, and am not seeing what you are. Appreciate any input you can give, I am still fairly new at this.


  5. #5
    I agree with Laura. These two codes have a '1' indicator on the CCI edits which means they are billable under certain circumstances, but would require modifier 59.

  6. #6
    I agree with Laura and kandigrl79 too.
    Girish Dadhich, CPC

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