Otolaryngology Coding Alert

Question: When an otolaryngologist performs an operation through the same incision as the primary procedure, our internal auditor recommends using modifier -52 (Reduced services) instead of -51 (Multiple procedures) on the second procedure. Is this appropriate coding?

Wisconsin Subscriber

Answer: No, CPT created modifier -51 for multiple procedures. The modifier triggers Medicare and some private payers to cut subsequent- procedure pay in half. The reduction accounts for the "reduced services" of the surgeon performing the operation through the same incision.

For instance, your otolaryngologist performs a total thyroidectomy with same-side modified radical neck dissection (RND). You should report 60240 (Thyroidectomy, total or complete) for the thyroidectomy and 38724 (Cervical lymphadenectomy [modified radical neck dissection]) for the modified RND. To inform the payer that the surgeon performed multiple procedures, append modifier -51 to the lesser-valued procedure, the thyroidectomy (60240-51).

Both 60240 and 38724 include relative value units for opening and closing the patient. But, the multiple- procedure rules reduce the second procedure by 50 percent. Thus, the carrier will cut $477.95 from 60240 to compensate for the decreased work.
 
If your auditor insists on her interpretation, ask her to show you the rule in writing. You can also point to CPT's modifier definitions in Appendix A.