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Q/A: Which Modifiers to Use When Billing 44005 and 36556 Together

March 26th, 2018 - Chris Woolstenhulme QCC, CMCS, CPC, CMRS
Categories:   CPT® Coding   Modifiers   Denials & Denial Management  
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Q: I have a denial for 44005 and 36556 being billed together. I added modifiers 51, 59, and Q6 to 36556 but I am afraid it will deny again?

A: Take a look at how you used your modifiers; you would not report both Modifier 51 and Modifier 59 on the same code.

44005 - Enterolysis (freeing of intestinal adhesion) (separate procedure)
36556 - Insertion of the non-tunneled centrally inserted central venous catheter; age 5 years or older

Modifier 51 - Multiple Procedures
Modifier 59 - Distinct Procedural Service

Modifier 59 should be appended to the “Separate Procedure” per AMA

Per AMA Guidelines, “When a procedure or service that is designated as a “separate procedure” is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/ services by appending modifier 59 to the specific “separate procedure” code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries).”

Using modifier 51 may depend on your carrier; there are some carriers that do not require the use of Modifier 51 when using this modifier you will usually receive reduced reimbursement.

Modifier 51 indicates: The same procedure performed on different sites; Multiple operations during the same session; or One procedure performed multiple times.

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