Wiki Can 51 and 59 be appended to the same CPT?

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Yes. They have different uses. I've always felt like modifier 51 is a kind of redundant modifier. It's added to subsequent codes to indicate that there are multiple procedures. For example:
First procedure
Second procedure-51
Third procedure-51

Modifier 59 is used to unbundle one code from another. For example:
92928
93458-51-59
93306-51
I added 51 to the 2nd and 3rd procedures because there are multiple procedures. I added the 59 to the 93458 to unbundle it from the 92928.

Always remember that just because you can unbundle, doesn't mean you should. You still have to justify it.
 
Regarding -51, you should check with your carrier.
I know my MAC has specifically issued guidance NOT to use -51 and the carrier will add when appropriate. The issue with adding -51 is that it tells the payor - pay me 50% on this code. So, if you add it to the code with lower RVUs, you will get accurate payment. If you add it to the code with higher RVUs, you will be underpaid.
Using rounded figures, if allowable for CPT1 is $250 and allowable for CPT2 is $800, correct payment would be
CPT2 $800
CPT1 $125 (1/2 of $250 and insurance will auto-append mod -51)
Total payment: $925
If you billed as CPT1, CPT2-51, you are telling the carrier to pay:
CPT1 $250
CPT2 -51 $400 (1/2 of $800)
Total payment: $650
Depending on the carrier, some software will strip the -51, and then apply to codes that are not the highest RVU or fee schedule and you receive accurate payment even if you put -51 on the highest value code. Others will not and you will actually be underpaid ($275 in this example).
 
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