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Modifier 51 or 59

  1. Default Modifier 51 or 59
    Medical Coding Books
    Can I use modifier 51 on procedures, when Dr does more than 1? Thanks Nancy

  2. Default
    Modifier -51 is used when multiple procedures, other than the E/M services, are performed at the same session by the same provider.

    Modifier -59 is used when the procedures not usually performed together are performed, are distinct, and are medically necessary.

    Example for modifier -59: A patient comes in for removal of a foreign body from ear which he performs, then the pysician notices that the patient has an abcess on the patient's hand and decides to do an incision and drainage. You would append the modifier -59 to the incision and drainage procedure.
    Last edited by TonyaMichelle; 01-13-2012 at 10:23 AM.

  3. #3
    Default Modifier 59

    Thanks for the example on clarifying the use of modifier 59. It makes a big difference when an example is used; especially for new coder as myself.

    Vanessa CPC

  4. Default
    The explanation is correct but you need to actually check the cpt code because there are some out there that won't take mod 51 but will take mod 59.

    Just like the mod 50. Even tho most codes will take mod 50 some insurance won't and want you to break them out.

    So you need to have some kind of software system like Encoder that has everything you need to know about that code (RUV's, modifiers, CCI, etc)

  5. #5
    Just remember that CPT add-on codes are modifier 51 exempt. Meaning those codes would not be subjected to the 50% reimbursement rate when billed with the primary procedure.

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