Saturday, April 16, 2011

What is Modifier -51 and when to use?

When and How Do I Use Modifier -51? What is Modifier -51 anyway?

Modifier -51, Multiple Procedures

This modifier is used when reporting multiple procedures performed by the same physician on the
same day. Do not use this modifier for "add-on" codes (see appendix D of the CPT Code book). Do
not use this modifier for codes with "modifier -51 exempt" symbol (see appendix E of the CPT Code
book). Do not use this modifier with an E/M code. This modifier can only be used by the same
physician on the same day who performed the procedure.

Coding tip: List the highest reimbursable code (after the main procedure code) based on the fee
schedule.

Bilateral Procedures

A -50 modifier indicates that a bilateral procedure was performed. Providers should submit the appropriate Procedure  code on one claim line, append modifier -50, and place a “1” in the “units” column of the claim form. These claims must be submitted hard copy with operative reports attached.

The bilateral modifier can only be appended to the Procedure  code if the procedure can be surgically performed bilaterally. The -50 modifier is not to be added if the Procedure  definition reads “unilateral or bilateral”.

50 – Bilateral Procedure Procedure was performed bilaterally during the same operative session Attach supporting documentation; bill on a single line with 1 unit 150% of the fee on file 51 – Multiple Procedures More than one procedure was performed during the same operative session Attach supporting documentation; use the modifier on all procedures except the primary one 100% of the fee on file for primary; 50% of the fee on file for all others 52 – Reduced Services Service or procedure is reduced at the physician’s election Attach supporting documentation 75% of the fee on file 54 – Surgical Care Only Surgical procedure performed by physician when another physician provides pre- and/or postoperative management 70% of the fee on file 55 – Postoperative Management Only Postoperative management only when another physician has performed
the surgical procedure 20% of the fee on file 

No comments:

Post a Comment

Most read cpt modifiers