Dermatology Coding Alert

Question: Our dermatologist often performs multiple procedures. Do I have to append modifier 51 every time?

Idaho Subscriber

Answer: No. Your CPT manual designates codes that are exempt from modifier 51 (Multiple procedures) with the Ø symbol to the left of the code.
 
Your manual may also offer a complete list of modifier 51 exempt codes in an appendix. The list is "a summary of CPT codes that are exempt from the use of modifier 51 but have NOT been designated as CPT add-on procedures/services," according to CPT 2006.
 
Important: Many payers -- including most Medicare carriers -- don't want you to use modifier 51. The payer will automatically sort the procedures on your claim in order from highest to lowest RVUs. The payer will pay the highest-ranked procedure at 100 percent and any additional surgical procedures at 50 percent.
 
And don't forget -- modifier 51 is used only by physicians and imaging centers, not by hospitals.