Like modifier 51, modifier 59 also has payment implications. Modifier 25 is used to denote a significantly separately identifiable E/M service. Like modifier 51, modifier 59 should not be applied to an E/M service. While modifier 51 and 59 both apply to additional procedures performed on the same date of service as the primary procedure, modifier 51 differs from modifier 59 in that it applies to procedures that may be more commonly expected to be performed during the same session. Separate incision, excision, injury or body part.Different procedure distinct from the first procedure. Different session or encounter on the same date of service.Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation. Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Many payers will apply a multiple procedure reduction to each additional procedure after the first reported code so be sure to list the most complex procedure first on your claims and append the modifier to any additional services reported when the situation calls for use of modifier 51. Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes Intubation, endotracheal, emergency procedureĪrterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure) percutaneous Codes on this list that are most relevant to anesthesiology practices are: 31500 They are noted in CPT with the symbol and are also listed in CPT’s Appendix E. Paravertebral block (PVB), (paraspinous block), thoracic second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary procedureĬertain codes are designated as Modifier 51 exempt. Paravertebral block (PVB), (paraspinous block), thoracic single injection site (includes imaging guidance, when performed) For example, modifier 51 would not be appended to CPT code 64462 as it is an add-on code and would be used for any additional injection sites per its definition. Modifier 51 is not appended to add-on codes. There are instances where multiple procedures are performed but modifier 51 is not appropriate. It is not to be used when a procedure is performed along with an Evaluation and Management (E/M) service. Modifier 51 comes into play only when two or more procedures are performed. A single procedure performed multiple times at the same site.A single procedure performed multiple times at different sites.Different procedures performed at the same session.Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session. This Timely Topic covers the differences between these two modifiers. Modifiers 51 and 59 are both used when multiple services are performed during a single encounter, but they serve different purposes. Modifiers provide additional information about CPT® codes submitted and services rendered without changing the definition of the procedure code itself.
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