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Thread: Modifier 51 vs 59

  1. #1

    Default Modifier 51 vs 59

    Promo: Code Books
    Can someone explain to me when I would use a -59 mod and a -51 mod if there are multiple surgeries for example:

    L/S cystectomy and H/S D&C (51 or 59)
    or
    58558 and 57065 (51or 59)

    or please give me other examples!!

    Any assistance is appreciated,

    Dawn
    Dawn Smith, CPC
    [email]dsmith28@iuhealth.org

  2. #2
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    The 51 modifier is basically letting the carrier know there are more than one procedure (multiple procedures performed) (not used in some settings, depends on who you are billing for)

    The 59 modifier is to let the carrier know its a separately identifiable different location/site. (trying to sum this up but this one can be much more complicated)

    Lets say you are having the same procedure done on two different toes. The CPT code is exactly the same. You would want to identify the 2nd code with the 59 modifier otherwise they bundle them.

    28285-TA
    28285-59-T1

    Hope this helps.
    Mary

  3. #3
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    Default 51 Vs 59

    If you had two 36556 performed, would you use a 51 or 59?

  4. #4
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    If you are billing for the surgeon and to a carrier that requires the 51 modifier, then it would look like this:

    36556-51
    36556-59-51 (providing documentation supports that this is a separate site)

  5. #5
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    In addition to Mbort's comments; below is a link that does gives examples of modifier 59. Not as fun as reading the comics but I find it informative.


    http://www.cms.hhs.gov/NationalCorre...modifier59.pdf
    Last edited by RebeccaWoodward*; 07-16-2008 at 05:59 PM.

  6. #6
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    If I coded two 36556 I would code it like this:
    36556
    36556.51
    or
    36556
    36556.59 (depending on what carrier, because some do NOT like the .51)
    But, why are you coding two insertions of Non-Tunneled Centrally Inserted Central Venous Catheters anyway? Just curious...
    Donna, CPC, CPC-H

  7. #7
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    Default

    2 different veins

  8. #8
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    I see.... well, again - in my opinion it would be either:
    36556
    36556.51
    or
    36556
    36556.59
    I've never used a .59.51 together - I'm going to look into that usage a bit more tomorrow...
    Donna, CPC, CPC-H

  9. #9
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    Hi,

    I see the (-51) modifier as an idicator to payors that multiple procedures were done during one operative session. By indicating which of the multiple procedures is "primary", I facilitate issuance of reimbursement. As you know, many payors allow for 100% of allowable for only the primary procedure & drop payment for subsequent procedures to 75%, 50% or 25%.

    Modifier (-59) is more of a "bundling/unbundling" modifier. It is typically used to indicate that procedures normally considered "components" of one another and therefore not separately reimbursable, are in certain cases to be looked at "individually". The CCI Edits is utilized to determine which cpt codes are considered "bundled". I don't know of any other application in which this modifier should be utilized with the exception of "duplicate" procedures, as mentioned in a prior post.

    I hope this info helps & Good Luck!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  10. #10

    Default Modifier 51 vs 59

    Thank you to all that responded

    Dawn
    Dawn Smith, CPC
    [email]dsmith28@iuhealth.org

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