Teresa Posted Tue 30th of September, 2014 21:41:03 PM
I am new to Urology coding and was informed that they use these two modifiers in combination a lot to get paid. I have never heard of this. Could you please explain when this is necessary to do so?
SuperCoder Answered Wed 01st of October, 2014 18:31:43 PM
Thank you for your question.
Modifier 51 would be used when more than one procedure is performed on the same day with the same physician.
Modifier 59 is used to identify that the procedure is separately identifiable from the other procedure(s) performed, usually procedures that are bundled.
Using modifier 51 is letting the payer know that more than one procedure was done, adding the 59 to an additional code as well lets the payer know that there was another procedure done but maybe another site/location, and it should be reimbursed. When using these modifiers together it is important to send in supporting documentation with the claim.
Teresa Posted Thu 02nd of October, 2014 11:57:14 AM
Okay so my example is I was working with a co-worker and a procedure was coded as follows:
I guess my question is, is this coded correctly? I didn't see any CCI edits that would require the use of modifier 59.
SuperCoder Answered Fri 03rd of October, 2014 07:34:32 AM
In the case listed above, you would only be required to use modifier 51 to identify multiple procedures same day. You are correct with regards to CCI edits, the codes do not bundle, 59 is not required.