When you have a patient that has had multiple procedures performed, make sure that the group of procedures that were performed actually require modified 51 before you attach it. The CPT has a list of certain coding that are exempt from modifier 51. The CPT manual designates modifier 51 (Multiple procedures) exempt codes with a "circle with a slash" symbol to the left of the code for the services rendered.

There is usually a complete listing of modifier 51 exempt codes in an appendix. The list is "a summary of CPT codes that are exempt from the use of modifier 51 but have NOT been designated as CPT add-on procedures/services," according to CPT. As an example look up a code in your CPT. Arterial catheterization code 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) and you will see a symbol with a circle and a slash to the left of the code. This means you should report just the code without a modifier as it is assumed that other services will be performed along with the catheterization.

Be wary about using modifier 51 on each and every claim without checking. Many carriers and most importantly Medicare, will lower your reimbursement amount if you use Modifier 51 on your medical billing claims. The carriers sort the procedures from highest to lowest RVU and the highest ranked RVU gets paid at 100% reimbursement the rest get 50% or less reimbursement on procedures.

Get the best reimbursement possible for the procedures your practice performs and make sure that your staff is coding and billing your medical billing claims properly.

Labels: medical-billing, medical-coding