Orthopedic Coding Alert

Question: My colleague and I have been debating the proper times to use modifiers 59 and 51. What are the differences between the two, and when should we use each one?

Nevada Subscriber

Answer: You would consider modifiers 59 (Distinct procedural service) and 51 (Multiple procedures) most commonly when coding multiple procedures. To master the modifiers, you must be familiar with each modifier and its proper use.

In general, use modifier 59 when you report two codes separately that are usually bundled together.

When using modifier 59, include documentation that proves that the surgeon performed the second procedure:

- during a second patient encounter or second patient session,

- using a separate incision or excision on the patient, and/or

- on a separate site or organ system.

You may use modifier 51 when the same physician performs more than one procedure during the same session and the second service is not a component of the first.

Example: The orthopedic surgeon performs shoulder arthroscopy with extensive debridement of an anterior and posterior labral tear. She then enters the subacromial space and performs subacromial decompression. She also performs distal clavicle resection and debrides the rotator cuff, and then she switches to a mini-open procedure and repairs the rotator cuff.

For this procedure, you should report the following:

- 23412 (Repair of ruptured musculotendinous cuff [e.g., rotator cuff] open; chronic) for the open rotator cuff repair

- 29826-59 (Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release) for the arthroscopic acromioplasty

- 29824-51 (... distal claviculectomy including distal articular surface [Mumford procedure]) for the arthroscopic distal clavicle excision

- 29823-59 (- debridement, extensive) for the arthroscopic extensive debridement.

Pay attention: Most payers and Medicare carriers do not require modifier 51 because their computers will automatically pick up the multiple procedures and process them according to the multiple-procedure rules.

Tip: When using either modifier 59 or modifier 51, be sure to append the modifier to the code with the lower relative value. Otherwise, you could lose out on legitimate reimbursement.