59 Modifier and 51 Modifier
59 Modifier = Distinct Procedural Service. Be careful with this code. It is not appended to a E/M code. This is to identify a distinct procedure done on the same day as another procedure. Modifier 59 was established to demonstrate that multiple, yet distince, services were provided to a patient on the same date of service by the same provider. Example may be but not limited to: Closed reduction of right radious and ulna, on the same day as a closed reduction of a tibia/fibula fracture on the same day and encounter.
If a E/M was done on the same day as a procedure, and the procedure was seperate from the E/M code, you would attach a 25 modifier to the E/M code. This is not to be used for a dicision to preform surgery. This is to be used for a minor procedure on the same day, and the procedure, must be seperate than the E/M service. This does not include a pre- or post op visit either. One example may be that the patient was coming in for the evaluation of diabetes glucose and medication check, then it was discovered that a foot ulcer needed to debrided in the office. The E/M code with a 25 modifier could be billed and the debridement would be Seperate.
51 modifier is for Multiple procedures other than E/M services are done on the same day, by the same physician. The primary procedure is listed first, then the following with a 51 modifier. Be sure to not attach a modifier to a "Modifier 51 Exempt" code. Do not reduce your fees for these services, as the insurance company will cut them anyway.
I would have to know more details in your example to help you further. Hope this is a help