51 vs. 59 CPT Modifier

[Laureen]

51 - Multiple Procedures: When multiple procedures, other than E/M services, physical medicine and rehabilitation services, or provision of supplies (eg, vaccines), are performed at the same session by the same provider, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s).
Note: This modifier should not be appended to designated add-on codes (see Appendix D).

• Volume discounting modifier
• When you apply it the money goes down
• First procedure takes no modifier, subsequent procedures take the modifier
• Think of it as multiple “surgical” type procedures.
• Not multiple as in an EM service + rapid stress test + stitches

59 - Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures or services, other than E/M services, that are not normally reported together but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than modifier 59. Only if no more descriptive modifier is available and the use of modifier 59 best explains the circumstances should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.

• Unbundling modifier
• When you apply it you get paid where otherwise you wouldn’t
• Modifier of Last Resort
• When you have a bundled pair per CCI with a superscript of 1 this is the modifier you’re likely to use