ED Coding and Reimbursement Alert
READER QUESTIONS:
Nail Down Modifier 51 Exemptions
Published on Sat Aug 12, 2006
Question: I heard a colleague discussing CPT codes that are exempt from modifier 51 (Multiple procedures). How can I find out which CPT codes are exempt from modifier 51?
California Subscriber
Answer: There are several exceptions to modifier 51 in CPT 2006--so many, in fact, that the AMA included a separate appendix with a list of all the codes that are exempt. Appendix E of CPT 2006 contains the section -Summary of CPT Codes Exempt From Modifier 51.-
The appendix features -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.
You can also recognize modifier 51 exceptions by the X symbol next to the code in CPT. For example, CPT code 99143 (Moderate sedation services ...; under 5 years of age, first 30 minutes intra-service time) is modifier 51 exempt. To the left of the CPT entry for 99143, you-ll notice the X symbol.
Try this: Get to know the modifier 51 exemptions in Appendix E of CPT. That way, you-ll know which codes are exceptions without having to hit the coding books for easy reference.
California Subscriber
Answer: There are several exceptions to modifier 51 in CPT 2006--so many, in fact, that the AMA included a separate appendix with a list of all the codes that are exempt. Appendix E of CPT 2006 contains the section -Summary of CPT Codes Exempt From Modifier 51.-
The appendix features -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.
You can also recognize modifier 51 exceptions by the X symbol next to the code in CPT. For example, CPT code 99143 (Moderate sedation services ...; under 5 years of age, first 30 minutes intra-service time) is modifier 51 exempt. To the left of the CPT entry for 99143, you-ll notice the X symbol.
Try this: Get to know the modifier 51 exemptions in Appendix E of CPT. That way, you-ll know which codes are exceptions without having to hit the coding books for easy reference.
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