Which modifier goes first

Modifier 51 impacts the payment amount, and modifier 59 affects whether the service will be paid at all. NCCI edits include a status indicator of 0, 1, or 9. A status indicator 1 identifies those code pairs not normally payable on the same date of service but may be paid in some circumstances when reported with an appropriate modifier often modifier 59 and supported by documentation that demonstrates why the edit is not applicable and payment is warranted. For example, the modifier may be used when reporting anesthesia care and a post-operative pain procedure when the procedure meets the criteria that allows for it to be separately reportable.

A previous Timely Topic gives additional examples of applying modifier 59 to anesthesia services. CPT instruction also tells us that modifier 59 should not be used when a more appropriate modifier is available. For example, if a procedure is performed bilaterally, modifier 50 would be the more appropriate modifier.

At this time, these modifiers are not required but may be used instead of modifier 59 when appropriate to the clinical scenario being billed.

It is important to understand correct coding and modifier usage to ensure appropriate payment for your services. As always, make sure you are familiar with instruction from your local carriers and ensure your documentation supports what and how you report your services.

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Back Podcasts. Back Quality and Practice Management. Back Research and Publications. Modifier 51 indicates that a second procedure was performed, and it is not a component code of the first procedure. There is no procedure-to-procedure bundling edit. Medicare contractors do not require modifier 51 on claims. Modifier 59 is used on a second procedure to indicate that although there is a procedure-to-procedure bundling edit for the second code with the first service, the second procedure meets the criteria of a distinct procedural service.

For lesions, for example, this most often means the second procedure was done on a different lesion than the first. Never use both modifier 51 and 59 on a single procedure code. Login to view the rest of this article. Many CPT modifiers require supplemental reports to the health insurance payer. We both want to code to the highest level of specificity and provide as much documentation as possible. If a modifier that requires justification of medical necessity is left without a supplemental report, the claim that procedure is on may very well be rejected.

Play Again Next Video. Physical Status Modifier for Anesthesia Anesthesia procedures have their own special set of modifiers, which are simple and correspond to the condition of the patient as the anesthesia is administered. These important additions to CPT codes give extra information about how, where and why a procedure was performed.