Urology Coding Alert

Question: I am uncertain about when I should use modifier 51. Do some carriers no longer accept it?

Wisconsin Subscriber

Answer: When your urologist treats a patient with multiple problems requiring multiple procedures, you would include modifier 51 (Multiple procedures) on your claim.

Rule of thumb: Modifier 51 is an informational-type modifier for use on the second, third, etc., surgical procedure performed on the same day as another procedure that you are reporting and seeking payment for.
Example: When a urologist performs a transvaginal sling procedure and an anterior vaginal repair in the same session, you can report both the sling procedure and the anterior repair. This means you may be able to:

• report 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]), and
• report 57240 (Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele) with modifier 51 appended.

The modifier shows the carrier that the urologist performed both procedures in the same session.

Check with your insurer first: Attaching modifier 51 to 57240 in the above example may not be necessary for all insurers. Many carriers, including Medicare, no longer require modifier 51. Processing claims electronically allows the carrier to recognize when your physician performs multiple procedures and automatically make the necessary reduction in payment. Remember to always list the highest-paying procedure code first.

Tip: Make a preemptive strike against denials by contacting your insurance carrier and asking the representative which method the insurer would prefer when reporting multiple surgical procedures.

Then, make a note of each payer's policy on coding multiple procedures so you can reference it quickly the next time a modifier 51 issue arises.

Remember: You can expect half the normal reimbursement for codes with modifier 51 attached. (Most insurance companies have adopted Medicare's policy of paying 50 percent for codes with modifier 51 appended.)

-- Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.