Internal Medicine Coding Alert
Modifier 51 Necessity Depends on Payer
Question: Do we need to append modifier 51 to our surgical claims on subsequent lines of service? Because the insurer will discount the second and subsequent procedures, you should make sure that you list the codes in RVU order, with the highest-paying code listed first. Follow this rule of thumb even if your insurer requires you to append modifier 51 before you submit the claim.
Alabama Subscriber
Answer: Most payers do not require you to append modifier 51 (Multiple procedures) to subsequent line items when your physician performs multiple surgeries. These insurers will process your claim in one of three ways:
• According to the relative value unit (RVU) order based on the Medicare Fee Schedule
• According to the insurer's own fee schedule
• In the order in which you listed the codes on your claim.
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