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51 versus 59 modifers?
Could someone please explain the differences between the 51 and 59 modifiers and give examples of how to use them?
Thanks.
51 and 59
CPT Modifier -51 indicates that you did more than one procedure at the same session. For example, if you excise a benign skin lesion with an excised diameter over 4.0 cm from a patient's chest and close the defect using a layered closure, you would submit code 11406 ("Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter over 4.0 cm") and 12032-51 ("Layer closure of wounds of scalp, axilla, trunk and/or extremities [excluding hands and feet]; 2.6 cm to 7.5 cm"). Since payers, such as Medicare, typically reduce the fee for the code with modifier -51 attached by about 50 percent, you should attach it to the lesser-valued service so that you are paid in full for the more expensive procedure. Medicare does not require modifier -51.
CPT Modifier -59 indicates that two services not normally reported separately are appropriately reported separately under the circumstances. Modifier -59 should be attached to the lesser valued of the two services or to the code, regardless of value, that would otherwise be denied or is a component of another, more comprehensive code. This modifier is usually considered a last resort, since its descriptor says that it should only be used "if no more descriptive modifier is available, and the use of modifier -59 best explains the circumstances."
example:This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. CCI Edit: Column 1 Code/Column 2 Code 95903/95900
CPT Code 95903 – Nerve conduction, amplitude and latency/velocity
study, each nerve; motor, with F-wave study
CPT Code 95900 - Nerve conduction, amplitude and latency/velocity
study, each nerve; motor, without F-wave study
Modifier -59 is:
1) Only appropriate if the two procedures are actually performed on
different nerves or in separate patient encounters
51 vs 59 modifiers
If you are a hospital coder, they do not report modifier 51. Multiple procedures will be reported using modifier 59. if separately identifiable.
51 versus 59 modifier
Look at the article:
Multiple Surgical Procedures
(Search for it in the search box)
It provides a foolproof method of deciding which modifier to use, and why.