The multiple procedure code Modifier 51, causes some confusion among medical billing professionals because it relates to multiple procedures performed but what many medical coders miss is the fact it only applies to multiple procedures performed by physicians and imaging centers. Using this modifier can get your claim denied and cause a large delay in receiving reimbursements.

Carriers already assume during a hospital stay that multiple procedures will already be performed therefore designation of the exact nature and type of services rendered by the attending physician will still suffice for hospital medical billing claims. The CPT manual designates modifier 51 (Multiple procedures) exempt codes with a "circle with a slash" symbol to the left of the code.

Pay close attention to those codes which don't need modifier 51. Certain types of services don't require the use of the modifier for add on services. Sarterial catheterization code 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) and you'll see a symbol to the left of the code. That means when a radiologist performs this service on a patient along with another procedure, you should report only 36620 without modifier 51.

Medicare is especially sticky about the use of modifier 51. Your medical billing claim will automatically be sorted by procedure performed on your medical billing claim from highest to lowest RVUs. The highest ranking service performed will normally reimburse at 100% and all remaining services at around 50%.

If your practice is suffering from multiple cases of medical billing denial or rejection; it most likely isn't your carrier but the use of outdated coding or weak documentation. If your medical billing isn't bringing in the revenue flow it should, it's time to consult with a medical billing partner and get fully reimbursed for the procedures you perform.

Labels: medical-billing, medical-coding, modifier-51