Anesthesia Coding Alert

Question: Does modifier -51 apply to anesthesia? If so, how?

Texas Subscriber

Answer: You can use modifier -51 (multiple procedures) for anesthesia in certain situations, for example when an anesthesiologist performs multiple procedures other than E/M services (e.g., multiple trigger-point injections) at the same session. In this example, code the first injection 20550* (injection, tendon sheath, ligament, trigger points or ganglion cyst), and report additional injections with 20550-51. Some carriers, such as Empire Medicare in New York, ask providers not to append the modifier because its system automatically appends the modifier when necessary. Claims submitted to Empire with modifier -51 reportedly are paid at one-fourth the value instead of half. And most other carriers pay procedures with modifier -51 appended at a 50 percent rate.

Tip: Dont reduce your rate for procedures you submit with modifier -51 because in many cases the payer will further reduce payment. Also, make sure your carrier accepts -51 for anesthesia procedures and follow its guidelines.