Wiki Billing Modifier 51 and 59

[kenkie79]

Can you bill modifier 51 and 59 together? One of my docs did an endometrial ablation (58563) for Menorrhagia and Metrorrhagia and a Hysteroscopy with polyp removal (58561). I coded the Hysteroscopy as primary and the Ablation as the secondary code. Do I bill that second CPT with 51 and 59 or just 59?

 

[capricew]

Medicare no longer requires you to report mod 51 on additional line items as their programs will automatically add it to all codes that are not 51 exempt. If this is for commercial payers, you need to check with each individual payer on whether they want 51 reported or not. In my state, NV, Medicaid is the only carrier that required we still report 51 on subsequent charge lines.

Hope this helps!

 

[Claudia Yoakum-Watson]

Yes, Modifier 59 indicates the services is distinctly different than the primary service and modifier 51 indicates the service is subject to multiple surgery reductions. There has been a lot of discussion about this over the year. Keep in mind that some carriers don't require modifier 51.

 

[nsteinhauser]

If the path came back as a polyp, you would choose 58558 for 'hysteroscopy with polypectomy' which is not separately reportable with the 58563 hysteroscopy with endometrial ablation. If pathology indicated a leiomyoma (such as a fibroid), then you would choose the 58561. Just a thought.