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Modifier 51 vs 59 - multiple surgeries

  1. #1
    Default Modifier 51 vs 59 - multiple surgeries
    Medical Coding 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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    outdated response
    Last edited by mbort; 07-13-2017 at 10:25 AM. Reason: outdated response

  3. #3
    Default 51 Vs 59
    If you had two 36556 performed, would you use a 51 or 59?

  4. #4
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    outdated response
    Last edited by mbort; 07-13-2017 at 10:26 AM. Reason: outdated response

  5. #5
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    North Carolina
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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 04:59 PM.

  6. #6
    Location
    Duluth, Minnesota
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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
    Default
    2 different veins

  8. #8
    Location
    Duluth, Minnesota
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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
    Default
    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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