JETGEN
New
I the doctor performs a colonoscopy with a cold biopsy and an EGD with a biopsy, would this be coded correctly with a 51 modifier on the EGD?
44380 , 43239-51
44380 , 43239-51
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Wiki Modifiers for multiple procedures
- Thread starter JETGEN
- Start date
bwalters
Contributor
JETGEN
New
No 51 on 43239, because it is in another family?
JenReyn99
Guru
I always use a 51, just for good measure, but the information that seems to be coming out now is that the 51 is becoming more obsolete, most payers are not working with it anymore. I bill gastro for both physicians and an ASC, and I always 51 modify it, but it isn't necessary. You can get your claims paid without the 51. The only exception to this that I have found information on is the EGD with dilation, 43450, this one requires a 51 when it is billed with a straight EGD. Here is some info I thought you'd find helpful on the 51:
• Used to indicate that the physician performed more
than one procedure on the same patient during the
same session.
• When reporting a multiple surgical session, report
the major surgery without the 51 modifier and
append each additional procedure with a 51
modifier. Payment for this is based on 100% of
Medicare allowable for the major and 50% of
Medicare allowable for each additional. Please note
that some procedures are not subject to the
multiple surgery reduction guidelines.
It's not absolutely necessary, but it's not going to hurt you if you use it. So it's kind of up to you. If anyone else has any different info, please share, because this is what I have researched and read in the Coding Edge and other coding sources. :0)
• Used to indicate that the physician performed more
than one procedure on the same patient during the
same session.
• When reporting a multiple surgical session, report
the major surgery without the 51 modifier and
append each additional procedure with a 51
modifier. Payment for this is based on 100% of
Medicare allowable for the major and 50% of
Medicare allowable for each additional. Please note
that some procedures are not subject to the
multiple surgery reduction guidelines.
It's not absolutely necessary, but it's not going to hurt you if you use it. So it's kind of up to you. If anyone else has any different info, please share, because this is what I have researched and read in the Coding Edge and other coding sources. :0)
KRED
Contributor
I would use modifier 59.
mitchellde
True Blue
No need for a 59. The two procedures are already distinct and separate by procedure definition. Under no circumstance would you ever perform one of these procedures via the same route. in other words you would never examine the esophagus with a colonoscopic approach. when the procedures are distinct by definition, then you would not use a 59.
KRED
Contributor
Which modifier would you use? Also, we have noticed that a lot of carriers do not recognize modifier 51.
mitchellde
True Blue
If they do not recognize the 51 then no modifier is needed. Just because you put two procedure codes on a claim does not mean you must use a modifier.
JenReyn99
Guru
I agree wholeheartedly with Debra. Like I stated in my prior comments, the 51 is becoming more obsolete, and is not a necessary modifier, and the 59 definitely doesn't work in this case. I'm glad you posted the above reasoning on that Debra, that's what I always say too, and I get arguments all around. The 59 is not applicable to procedures done via separate routes that are by nature distinct and separate already!
KRED
Contributor
Thank you for the clarification.
I talked to some of my colleagues and they inform me that when we did not use a modifier, the claims were being denied as duplicates. Modifier 51 was not recognized and modifier 59 had to be used in order for our claims to be processed.
Again, thank you for the clarification.
I talked to some of my colleagues and they inform me that when we did not use a modifier, the claims were being denied as duplicates. Modifier 51 was not recognized and modifier 59 had to be used in order for our claims to be processed.
Again, thank you for the clarification.
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