# Modifier -51/-59 Dilemma AGAIN!



## Skinne (Mar 11, 2008)

Re:  Integumentary System - when coding repairs of wounds and the anatomic groups are different, would the second code, which would be a different anatomic group than the first, take a -59 modifier or a - 51? The CPT book states that if the classifications are different, the second code would take a  -51 modifier. However, it doesn't say anything if the anatomic groups are different. H E L P P P P P P P!

Sheryl Kinne


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## PatriciaCPC (Mar 14, 2008)

Best bet... check the guidelines with your payor. Some of them REQUIRE 59 no matter the case.


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## NFBarner (Mar 14, 2008)

I would check the CPT codes in the CCI edits (for those insurance companies that follow Medicare).  If the CPT codes are not bundled, then I would report them with a 51 modifier to show multiple procedures.  If it shows that they are bundled but has a (1) next to them, showing that they can be unbundled with different anatomical areas, then I would report the CPT codes with a 59 modifier.


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## FTessaBartels (Mar 19, 2008)

*It depends ...*

CPT says to "Sum lengths of repairs for each group of anatomic sites" for the repair codes.
For Modifier 59 CPT specifies "... different site...separate incision..."

So, as an example:
Patient arrives with multiple wounds w/ repairs as follows:
 Left upper arm wound 2.5 cm - simple repair
 Left thigh wound 3.2 cm - simple repair
 Left thigh wound 1.8 cm - intermediate repair

You would add together the lengths of 1st and 2d wounds to code CPT 12002
You would separately code 3d wound - 12031[59]

I'd use the 59 modifier because it is a "*separate incision*"

Hope that helps.
Tessa Bartels CPC


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## dbryant (Mar 20, 2008)

*Modifier -51 versus -59 Dilemma*

I agree with Tessa

The rule of thumb is.  If you are working in the same site doing multiple
procedures before closing then you would need to use -51 on the second or third cpt code(s). If that incision is closed and you move to a different anatomic site and make a "separate" incision you would use -59 on the first cpt code. Say for instance multiple procedures are also done in that separate incision/site as well you would append -51/59 to the second or third 
cpt code(s).     

Dbryant, M.A.,CPC


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