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Modifier's 59 and 51

  1. Smile Modifier's 59 and 51
    Medical Coding Books
    Does anyone how using modifier 51 and 59 affects reimbursement. Our physicians are payed according to work RVU and we have Ct surgeons and vascular surgeons and so we use modifier 59 quite a bit. So I need some clarification on how this affects our reimbursement.

    Thanks for any help.

  2. #2
    Milwaukee WI
    Default Multiple surgery reduction
    The multiple surgery reduction will apply regardless of which modifier you are using. If the codes do not bundle, you should NOT be using the -59 modifier.

    Why the reduction?

    Because you do not need separate pre- and post-op care for additional procedures performed in the same operative session. Since all reimbursement for procedures includes payment for pre- and post-operative care, there will be a reduction in the payment for the second, third, etc procedures on a claim.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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