Primary Care Coding Alert

Coding #1: Modifier -51. Append modifier -51 to 12001, and bill 12011 separately. Even though the wounds were caused by the same accident, the physician treated each as a separate injury. The modifier -51 tells the carrier that this is a multiple surgical procedure. Because these lacerations are in two separately identified anatomic sites, each laceration was separately reported.

Coding #2: Modifier -59. To show that these are two separate injections and that you are not double-billing for one, use modifier -59. Report 20610, 20610-59. In the past, coders needed modifiers -51 and -59 for trigger point injections, but CPT 2002 revised and added new trigger point codes that no longer require modifiers. For more on this, see the article "Shoot for Dollars With Trigger Point Coding" in the September 2002 issue of Family Practice Coding Alert.

Coding #3: Modifier -51 and -59. Attach modifiers -51 and -59 to 11100 to indicate that both services were done at the same session and that the biopsy was from a different actinic keratosis than the one that was excised.

Note that if the FP biopsies and subsequently removes the same actinic keratosis lesion during the same operative session, you cannot be paid for both because even modifier -59 does not allow those procedures to be unbundled. You would, in that case, report only the code for the removal of the lesion, i.e., 11400.

Coding #4: Modifier -59. Append modifier -59 to the 93000. Because CCI bundles these two procedures together, the -59 tells the payer to separate them under these special circumstances. The EKG is the component procedure of the more comprehensive procedure, the stress test, and therefore gets the modifier.

Coding #5: Modifier -59 and modifier -51. Code 11401, 11401-59-51. The -59 unbundles the codes, telling the insurer that the lesions were separate and on two different anatomic sites, while the -51 indicates that multiple procedures were performed.

 Answers provided by Joy Newby, LPN, CPC, president of Joy Newby and Associates, a reimbursement consulting company in Indianapolis; Marie Felger, CPC, an American Academy of Professional Coders (AAPC) certified coding instructor with Joy Newby & Associates Inc. in Indianapolis; and Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City.