Wiki upper gi and colonoscopy same session

[kmdnine]

I've always been under the impression that if these two procedures are done at the same session, modifier -51 isn't utilized on the second procedure, (i.e., 45380 + 43235) because they are from two different endoscopic families, with different base codes. I'm now being told I'm incorrect, and that a modifier -51 is required. I'm curious as to how other GI coders handle these scenarios. I've never used any modifiers of any kind when coding these together.

 

[CodingKing]

Most payers don't want you to add modifier 51, they will do the multiple procedure reduction on their end.

 

[kmdnine]

Thought so

That’s what I thought. I found something on CMS’ website to back it up, but it’s all in reference to Medicare. I appreciate the input. Thank you.