Orthopedic Coding Alert

Question: Our orthopedist performed a carpal tunnel release (64721) followed by a trigger finger release (26055). Should we append modifier -51 or -59 to 26055?

California Subscriber

Answer: First, check with your carrier for guidelines on reporting these surgeries together some payers mandate that you report specific modifiers when performing certain surgeries on the same date. If this is not the case with your carrier, re-examine the two modifiers with respect to the services your orthopedist performed.

Modifier -59 (Distinct procedural service) would apply if the National Correct Coding Initiative (NCCI) maintained edits that bundle 64721 (Neuroplasty and/or transposition; median nerve at carpal tunnel) and 26055 (Tendon sheath incision [e.g., for trigger finger]). But NCCI does not bundle these codes.

In the absence of insurer guidance, you should append modifier -51 (Multiple procedures) to 26055. CPT says, "When multiple procedures, other than E/M services, are performed at the same session by the same provider, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending the '-51' modifier to the additional procedure or service code(s)."

Don't be surprised when your insurer reduces your fee for trigger finger release. Since Jan. 1, 1995, carriers have paid the second through fifth procedures at 50 percent of the total relative value units, paying the entire fee for only the primary procedure.

Some carriers use software that automatically detects second and subsequent procedures and reimburses them accordingly, thereby making modifier -51 unnecessary. Whether you append modifier -51 or your insurer automatically adds it, never reduce your fee when reporting multiple procedures. Your payer will base reimbursement on the fee that you report. If you charge less than the full fee, your insurer will still cut your payment in half.

  You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopaedic Associates in New Brunswick, N.J.