Wiki Modifier 51

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Modifier -51

Hi, tawneymurphy

I am trying to find the MLN that I used to have long time ago from Medicare stating that they prefer this modifier not be used in the claims. I have not used this modifier in over 13 years. Now I am in a new job and I am trying to find the documentation to substantiate this but I have not been able to find it in CMS website. If someone knows where I can find it please let me know.

Thank you
 
Hi

Hope the below info helps!!!

Modifier 51 Multiple Procedures

Modifier 51 designates multiple procedures that are rendered at the same operative session or on the same day. Modifier -51 (multiple procedures) must be used to indicate instances when multiple procedures, other than E/M services, physical medicine and rehabilitation services, or provision of supplies (e.g., vaccines), are performed at the same session by the same provider.

The medical records must clearly support the appropriate use of Modifier 51 (multiple procedures).


Inappropriate Usage

Modifier 51 appended to designated “add-on” codes.

Reporting on primary procedures and on base endoscopy procedures

Reporting to Evaluation and Management (E&M) CPT codes

Reporting to Physical Medicine and Rehabilitation services or provision of supplies (eg.vaccines)

Appending Modifier 51 to a CPT-4 designated Modifier 51 Exempt procedure code

Appending Modifier 51 to procedures that are considered components of the primary procedure

Appending Modifier 51 in instances when two or more physicians each perform distinctly different, unrelated surgeries on the same day for the same individual

Appending Modifier 51 when a more appropriate modifier exists to more accurately describe the scenario being reported.

Thanks,
Kokila Venkatesan CPC-A
 
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