Wiki Clarification on modifier 51 and 59

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sirisha

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The doctor has done cardiac catheriization diagnostically with stent placement.
So i have billed 92980 and 93458 with 26 and 59 modifiers.

But from the client side they want us to add 51 modifier also with 26 and 59 as they get denials from insurance.Can anybody clarify me in this?

Should i bill 26,59,51 with 93458.If yes the reasons plz.........
 
I guess once you append 59 modifier, it is clear that the two procedures are distinct from each other. Then what is the point of assigning 51? I don't think. Please clarify with the client, that will be better.

Brightwin
 
59 indicates distinct and separate procedures, often used to unbundle procedures,
51 indicates that the procedures were performed in the same procedural setting.
a cardiac cath followed by stent placement, will be bundled with the stent placement and it should not be unbundled, once a definitive procedure has been performed you do not billed for the diagnostic as that is the approach. much like the diagnositic colonoscopy and the polypectomy cannot be billed together.
 
mitchellde said:
59 indicates distinct and separate procedures, often used to unbundle procedures,
51 indicates that the procedures were performed in the same procedural setting.
a cardiac cath followed by stent placement, will be bundled with the stent placement and it should not be unbundled, once a definitive procedure has been performed you do not billed for the diagnostic as that is the approach. much like the diagnositic colonoscopy and the polypectomy cannot be billed together.
Click to expand...

Sorry I didn't think of unbundling and I understand now. Thanks Debra
 
Procedure 92980 should be reported with 59 to specify distinct anatomical site and 51 for multiple procedure as this procedure has a lowere RVU than 93458.

Modifier 26 can be appended to 93458 only. 26 does not apply to 92980 as it has PCTC indicator 0
 
You may use the 59 modifier only if you can show by report that a different vessel was cathed from the vessel (s) stented. The cath is the diagnostic part, the stent placement is the therapeutic part. Unless a different site is involved you cannot code the diagnostic once the therapeutic has been performed on the same site. If you were to use the 59 modifier it would go on the column 2 code as that is the component, it is not dependent on the RVU for modifier placement. The last time I looked the 93458 was the column 2 code and would be the one with the modifier
From the CMS site:
NOTE: The 929xx codes in column 1 describe coronary therapies. The 934xx codes in column 2 are diagnostic procedures. You should never use the 934xx diagnostic codes in column 2 to report catheter placement and coronary angiography performed as an integral part of the therapeutic column 1 services
 
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