Otolaryngology Coding Alert

Question: Do we need to append modifier 51 to our surgical claims on subsequent lines of service?


Alabama Subscriber
 

Answer: Most payers do not require you to append modifier 51 (Multiple procedures) to subsequent line items when your physician performs multiple surgeries. These insurers will process your claim in one of three ways:

- According to the relative value unit (RVU) order based on the Medicare Fee Schedule

- According to the insurer's own fee schedule

- In the order in which you listed the codes on your claim.

Because the insurer will discount the second and subsequent procedures, make sure you list the codes in RVU order, with the highest-paying code listed first. Or organize your codes from the highest fee to the lowest fee, based on that payer's fee schedule. Follow this rule of thumb even if your insurer requires you to append modifier 51 before you submit the claim.

Important: Some Medicare carriers specifically instruct practices not to append modifier 51 to their claims, so be sure to check with your payer before you bill.