Modifiers are very important in medical coding. We have already discussed previously about 25 and 27 Modifier. It is quite complicated to choose the correct modifier and use them with CPT Code. Today again we will discuss about modifier 47, 50 and 51. These modifiers are very common to use during surgery coding. Let us learn each modifier one by one.
Read also: Coding tips for Thoracentesis and Paracentesis
When to use Modifier -47
Modifier -47 is used to report a surgical Procedure in which the surgeon administers anesthesia (regional or general anesthesia) in addition to performing the surgery. Modifier 47 should not be used when a local anesthesia is used. The payment through a third party payer for modifier 47 should be based on the time spent administering the anesthesia. The surgery CPT code will be reported with modifier 47 by the surgeon who is acting as an anesthelogist. Modifier 47 should always be used with surgery CPT codes and never with the anesthesia codes.
Read also: Coding tips for Screening Colonoscopy CPT code
When to use Modifier -50
Modifier -50 is used if the same procedure is performed on a mirror-image part of the body, using the same CPTprocedure code to indicate a bilateral procedure. There are different methods the payer wants bilateral procedures to be submitted on the claim form. Modifier 50 is the coding practice of choice when reporting bilateral procedures. The Medicare bilateral indicator is 1 or 3. 50 modifier is used when an identical procedure performed on both sides of the paired organ. Do not use RT or LT modifier in place of 50 modifier. RT and LT modifier should be used only when a procedure is performed on one side of the paired organ.
The physician performs a surgical sinus endoscopy with total ethmoidectomy, 31255, on the left and right ethmoid sinuses (bilateral).
1. Using modifier -50, the service would usually be reported as 31255 and 31255-50.
2. Using the Medicare modifiers for sides (-LT, left side and -RT, right side), the service would be reported as 31255-LT and 31255-RT.
3. Using the one-line format, the service would be reported as 31255-50.
The most specific method of reporting is the second format, as it indicates not only the number of procedures, but also the side of the body.
Read also: Coding Tips for Tunneled catheter removal CPT code
When to use Modifier -51
Multiple Procedures
Modifier -51 is indicated when multiple procedures are performed at the same session by the same provider. This modifier should not be appended to designated add-on codes. Assign modifier -51 when multiple procedures, other than the E/M services, are performed on the same day or at the same session by the same provider. When reporting multiple surgeries, the primary procedure (procedure with the highest relative value unit) should be listed first on the claim. Use of modifier 51 should be done carefully because many procedure or CPT codes include many different procedures bundled together in one code. It would be incorrect to report services separately if they are included (bundled) in the description for a code. Unbundling is assigning multiple codes when one code would fully describe the service or procedure. The assigning of multiple codes in such a case results in increased reimbursement and is considered fraud by a third-party payer.
However, if one code does not describe all of the procedures performed, and the secondary procedure is not considered a minor procedure that is incidental to the major procedure (and therefore bundled into the major procedure), each additional procedure may be reported by using modifier -51.
Read also: Become Expert in coding Z codes in ICD 10
Multiple procedures are reported in the following three significant circumstances:
· The same operation is performed on different sites.
For example: When an excision is 1 cm benign lesion done for patient of forearm and at the same time an excision of 2 cm benign lesion is done in the neck region. In such a case we will be coding two procedure codes for excision for forearm and neck with a modifier 51 to the second CPT code.
· Multiple operations are performed at the same operative session.
There is multiple procedure performed at the same operative session. Always code the primary procedure which is more extensive or major procedure and then followed by the minor procedures of decreasing order of complexity with 51 modifier. The primary procedure should be paid full, second procedure during the same session should be paid 50% and the third procedure should be paid 25% of the fee, if there are 3 procedures performed at the same time.
· The procedure is performed multiple times
Multiple procedures are also reported when the same procedure code is used to identify a service performed more than once during a single operative session. There are two ways to report procedures performed multiple times, depending on the requirements of the third-party payer.
This post first appeared on Interventional Radiology Medical Coding - Learn How To Code, please read the originial post: here
