Emergency Department Coding & Reimbursement Alert

Check CPT for Modifier -51 Exemptions

- Published on Fri, May 07, 2004

'Circle with a slash' sign indicates modifier -51 exempt code

Think you're ready for claims using modifier -51 (Multiple procedures)? Not if you don't know the exceptions to the modifier -- and how to spot them.

Appendix E of CPT 2004 contains a list of codes that are exempt from modifier -51. The list is "a summary of CPT Codes that are exempt from the use of modifier -51 but have not been designated as CPT add-on procedures/services," according to CPT. These modifier -51 exempt codes are also recognizable within the code listings of CPT; just look for a "circle with a slash" symbol to the left of the code.

To prevent red tape and increase your practice's productivity, get to know the exemptions before filing a claim with modifier -51.

Example: A patient presents with a pneumothorax and is in extremis. The physician intubates the patient before putting in a chest tube.

You would report 31500 (Intubation, endotracheal, emergency procedure) and 32020 (Tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema] [separate procedure]) without appending any modifiers. Both of these procedures are listed as -51 exempt in Appendix E of CPT, so there is no need to append the modifier to either code.

Get 14-Day Fully-Functional Free Trial of Physician Coder

Get access to all your specialty alerts and archived articles along with some comprehensive tools including:
  • Code Search for CPT®, HCPCS, ICD-9 and ICD-10
  • CCI Edits Checker
  • Part B Fees, MUEs
  • CPT-ICD-9 CrossRef
  • CPT® ↔ ICD-9 ↔ ICD-10 CM Crosswalk
  • LCD/NCD Lookup
  • CMS 1500 Claims Scrubber
  • NDC ↔ CPT/HCPCS CrossReference
First Name: *
Last Name: *
User Name: *
E-mail: *
Phone: *
Choose Speciality*
Please enter the characters shown in box*