Primary Care Coding Alert

Question: The doctor controlled a patient's nasal hemorrhage (30901) and removed a benign lesion from patient's temple (17110) during the same encounter. Should I report modifier 51 or 59?

New Hampshire Subscriber

Answer: Coding rules direct you to append modifier 51 (Multiple procedures) only when the physician completes multiple procedures during the same encounter, and to append modifier 59 (Distinct procedural service) only when the two procedures you want to submit are not normally submitted together but are appropriate under the circumstances. Modifier 59 is often used with code pairs that have an active bundling edit through the Correct Coding Initiative (CCI). Current CCI edits do not bundle codes 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method) and 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions).

You'll probably find different opinions on whether to append modifier 51 or 59. Some coders opt for modifier 51 because most payers will process the encounter as a multiple surgical reduction whether you include the modifier or not. Other coders recommend modifier 59 because reporting modifier 51 could set you up for one of three undesirable (or at least aggravating) outcomes: the payer doesn't reduce payment correctly; the payer denies the entire claim; or the payer requests additional documentation before considering payment. Of the two modifiers, modifier 51 is probably most appropriate in this instance.

Tip: Whichever modifier you select, append it to the procedure with the lowest RVUs (relative value units) -- in this case, code 30901 with 2.82 RVUs.

Also, double-check the code that you are submitting for the lesion removal. As noted, the code you indicated, 17110, is for destruction of a lesion by one of several methods. If the physician removed the lesion via excision, you will need to use a code from the series of codes for excision of benign skin lesions, 11400-11446.