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.
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