Modifer 51

We have a clinic that bills for TCC using CPT® codes 36011 and 37204. They put a modifier 51 on the 37204. From looking at the NCII edits, I don't believe either code should be modified. Any opinions?

Thank you,
Bonnie J. Flom, CMRS
Author of Mastering Medisoft

re: Modifer 51

-51 is used to let the carrier know multiple procedures were performed at the same session by the same provider (multiple reduction rules apply). Some carriers will automatically assign this modifier. This modifier is not used on add-on codes. Not to be confused with modifier -59 which will unbundle a code when appropriate.

I use to not use the -51 as often, but I do now because I was getting refund requests because the carrier(s) forgot to apply the multiple reduction rule. Their systems would automatically overlook this without the -51 therefore causing refund requests. It depends on your carrier because some will automatically apply this modifier when processing the claim(s).

It’s common sense that when more than one procedure is billed out then they should know its multiple procedures. What you have to remember is, our claim is talking to their computers, not a person and systems have flaws. The -51 (again, depending on the carrier) just helps to relay the correct information through their computer systems to help decrease any overpayment issues and helps to attach the correct processing application that applies.