As I am learning Cardiology and this is my 6th month in my first coding position, I am still a little frazzled on the usage of modifers -51 and -59. We have EncoderPro that helps us plug in our CPT's and dx but it ALWAYS wants me to use -51 when sometimes I feel I should be using -59. Is there anyone that can help me differentiate the two and when it is appropriate to use these modifiers in Cardiology Coding???
I appreciate any help I can get!
Brandy Edmondson, CPC
51 is for when multiple (non-E/M) procedures are performed by the same provider at the same encounter. Honestly, I really don't see a need for 51 very often, but you might run across it in cardiology here and there. It usually only affects pricing for the codes that have the modifier, so don't put it on your most expensive (primary) procedure.
Think of 59 as being
kind of like the 25 modifier, but for procedures. When you have more than one procedure done at the same time, you use modifier 59
if: A) They're not usually performed during the same encounter (mutually exclusive), B) One is generally considered to be included in the other, but this time, it's on a different area of the body, or C) You're billing two labs that can be described by the same code, but are testing for different strains/species of the same organism. The code pairs that require a 59 modifier will almost
always be somewhere on the NCCI edit tables, and they will have a status indicator of "1". Like the 51 modifier, 59 affects reimbursement; the key difference is, without adding a 59 modifier when it's needed, you
absolutely will have a denial, and it
does matter which code you put it on. You have to add the 59 modifier to the code you're trying to flag as "distinct" from the other procedures, so it will always go on the less extensive procedure (that would otherwise be bundled into something else). I hope that helped, and didn't make it more confusing!
