Radiology Coding Alert

Question: Do I have to append modifier 51 every time our radiologist performs multiple procedures?

Idaho Subscriber

Answer: No. Many codes are modifier 51 (Multiple procedures) exempt. All add-on codes are modifier 51 exempt, and your CPT manual designates other exempt codes with a "X" symbol to the left of the code.

Appendix D of the CPT manual contains a complete list of add-on codes, and Appendix E contains a complete list of other modifier 51 exempt codes.

Example: Look up insertion of long gastrointestinal tube code 44500 (Introduction of long gastrointestinal tube [e.g., Miller-Abbott] [separate procedure]), and you'll notice the X symbol to its left. That means when the radiologist performs the tube insertion in addition to another procedure, you should report 44500 without modifier 51 along with any other procedures performed.

Don't miss: Many payers -- including most Medicare carriers -- don't want you to append modifier 51. The payer will automatically sort the procedures on your claim in order from highest to lowest RVUs. The carrier will pay the highest-ranked procedure at 100 percent and any additional surgical procedures at 50 percent. And don't forget -- only physicians and imaging centers (not hospitals) should use modifier 51.

Note: CPT 2008 changes the full descriptor of modifier 51 to state, "When multiple procedures, other than E/M services, physical medicine and rehabilitation services, or provision of supplies (e.g., vaccines), are performed at the same session by the same provider," you should append 51 to second and subsequent codes (italics signify text added in CPT 2008).

And CPT removes many procedures from the modifier 51 exempt list for 2008. For example, thoracentesis code 32000 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) was modifier 51 exempt in 2007, but new thoracentesis code 32421 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) is not modifier 51 exempt for 2008.