Internal Medicine Coding Alert

In response to our article on coding for multiple endoscopic procedures (Case Study: Optimizing Pay-Up for Multiple Endoscopic Procedures Performed on the Same Day in the the August issue of Internal Medicine Coding Alert, page 61), we received a number of letters from readers who disagreed with the method we stated for attaching modifiers -51 (multiple procedures) and -59 (distinct procedural service).

In our article, we stated that when two endoscopic procedures in the same family of procedures are performed, the -59 modifier should be attached to the procedure with the highest allowable to indicate that it is a distinct procedural service from the other procedure listed.

We have since learned that some carriers will reduce the code with the modifier attached, although Medicare payment rules stipulate that the code with the highest allowable should be paid at 100 percent, with the remaining codes in the same family paid at the full amount minus the base fee for that family of codes. If you believe that you have been reimbursed improperly due to modifier usage, you should appeal to your carrier.

In addition, some carriers will reduce separate endoscopic procedures reported with the -51 modifier (multiple procedures) to 50 percent of the allowable, even though Medicare payment rules stipulate that, for these codes, the code with the highest allowable should be paid, with the lower-valued code paid at 50 percent.

Our source for the article, Glenn Littenberg, MD, a member of the CPT Advisory Panel and a practicing gastroenterologist, advises that requirements on modifier usage often vary from carrier to carrier and that attaching modifier -59 to the code with the highest allowable is what his carrier has instructed his practice to do. The same holds true when using the -51 modifier on both codes for endoscopies of different code families. However, other carriers may want the modifier applied in a different manner.