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Cynthia Posted Mon 26th of January, 2015 13:58:03 PM

our biller billed
a excision and repair as follows:
13121 modifier 51
is this a correct modifier?

SuperCoder Answered Mon 26th of January, 2015 15:02:33 PM

Thanks for your question. In this scenario, modifier 59; distinct procedural service would be the more appropriate modifier to use with 13121.

Cynthia Posted Mon 26th of January, 2015 15:12:35 PM

thank you

SuperCoder Answered Mon 26th of January, 2015 15:27:04 PM

You are welcome.

Cynthia Posted Sat 31st of January, 2015 10:22:23 AM

I have a problem with the proper modifier with the additional excisions done ex:
99213 -25 when do i use a 51 and when do i use a 59?

SuperCoder Answered Mon 02nd of February, 2015 11:32:55 AM

11441; Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm and 11400; Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less do not have any NCCI edits when billed together. You would not need to use any modifiers in relation to those two codes.

When billing the 11400 twice you would need a modifier if you have a reason for billing the two together such as separate structure. In that case you would need the 59 modifier for distinct procedural service. Become familiar with the difference between modifier 51 and modifier 59. While you should not expect modifier 51 to affect whether or not the payer reimburses, modifier 59, Distinct Procedural Service, can actually affect whether a payer reimburses a claim. Modifier 59 tips off the payer that certain performed services are not normally done together, but an exception is appropriate in a particular case. This case may be for a different session, patient encounter, procedure, site, or organ system. It may also include a separate incision/excision, separate lesion, or separate injury, according to the CPT® manual.

When multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s).

Appending modifier 51 to the second or third procedure tells the payer that the provider performed multiple procedures in the same operative session. The insurance typically reduces payment for each procedure after the first one performed. One way you can look at modifier 51 is to think of it as an informational modifier for use on the second, third, etc., surgical procedure performed on the same day. Keep in mind that Medicare does not want you to use modifier 51.

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