ED Coding and Reimbursement Alert

Question: I am uncertain about when I should use modifier 51. Do some carriers no longer accept it?

Wisconsin Subscriber

Answer: Including modifier 51 (Multiple procedures) on certain claims may not be necessary for all insurers.

Many carriers no longer require modifier 51. Processing claims electronically allows the carrier to recognize when your physician performs multiple procedures and automatically make the necessary reduction in payment. Remember to always list the highest-paying procedure code first.

Tip: Make a pre-emptive strike against denials by contacting your insurance carrier and asking the representative which method the insurer would prefer when reporting multiple surgical procedures. Then, make a note of each payer's policy on coding multiple procedures so you can reference it quickly the next time a modifier 51 issue arises.

Rule of thumb: Modifier 51 is an informational-type modifier for use on the second, third, etc., surgical procedure performed on the same day as another procedure that you are reporting and seeking payment for.

Example: The physician repairs a patient's 2 cm hand laceration and applies a finger splint. In this instance, you should report the following:

- 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk, and/or extremities [including hands and feet]; 2.5 cm or less) for the laceration repair

- 29130 (Application of finger splint; static) for the splint application - modifier 51 appended to 29130 to show that the procedures were separate -- if the insurer requires the modifier.

The modifier shows the carrier that the physician performed both procedures in the same session. You can expect half the normal reimbursement for codes with modifier 51 attached. Also, check Appendix E of the CPT manual for a summary of codes that are 51 modifier exempt.

-- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky,MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.