Orthopedic Coding Alert

You Be the Coder:

Multiple Procedure Rule Clarified

Published on Sat Apr 01, 2000

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: Dr. Becker performed repairs of the extensor carpi ulnaris, extensor digiti minimi, and extensor digitorum to the ring and small fingers of the patients left hand. We originally coded this with 25270 x5 without the modifier -51. The patients insurance company paid the appropriate amount for the first code and then cut the additional codes by 50 percent. I thought that when the CPT stated each tendon or each additional that the multiple procedure rule was not used.

Jodi Cornell
Office of Thomas Becker, MD, Gurnee, Ill.

Answer: Each tendon is not synonymous with each additional, and that has caused the confusion over the multiple procedure rule, which does apply here. If the code said each additional and the insurance company uses the RBRVS methodology for payment, there should be no reduction in payment for the second through fifth procedures in your scenario, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. The reduction in reimbursement is built into the RVU for the procedure if the each additional code is used with another procedure code.

However, 25270 (repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle) lists each tendon, so multiple rules apply since the same code is used for one procedure or for more than one.

Note: Modifier -51 (multiple procedures) should be used in this caseon the subsequent codes, not on the first one.