Cardiology Coding Alert

Question: Can I use modifier 51 with 36620 when my cardiologist performs a catheterization?

Idaho Subscriber

Answer: Look up arterial catheterization code 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) in your CPT manual, and you'll notice the symbol X to its left. That means when your cardiologist performs the catheterization in addition to another procedure, you should report 36620 without modifier 51 (Multiple procedures) along with any other procedures performed.
 
Important: Many payers -- including most Medicare carriers -- don't want you to use modifier 51. The payer automatically sorts the procedures on your claim in order from highest to lowest relative value units (RVUs). The payer then pays the highest-ranked procedure at 100 percent and any additional surgical procedures at 50 percent. On the other hand, many Medicaid payers still require you to properly apply modifier 51.

And don't forget -- only physicians and imaging centers use modifier 51, not hospitals.