Modifiers 50, 51 and 59 Clarification by AMCI

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thank you

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thank you

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well hello hello good morning or

afternoon depending on where you are and

it is just wonderful to see all of you

and some of you were just with me in

part two and yeah now I am in part three

with you guys and so typically I'm in

one and two but now I've kind of screwed

it up just a little bit so now I'm

straddling two and three and I am so

excited to be here with you all in this

phenomenal team that is part of part

three and they are gonna come right

after I'm done with my little bit and

they've got a lot of Scrump

deliciousness to share you guys know I'm

gonna relate it to some food don't you

you know that

so we are going to talk today about the

integumentary system and just as I told

you when you were in part two it feels

differently right all of these books

they work together they are a family but

each has its own personality and this

CPT manual is no different no different

so I'm gonna go and move right along

with we're gonna go ahead and talk about

the elephant in the room you might be

saying what what's what's the elephant

in the room oh it's so CPT modifiers

right it's the CPT modifiers I Who as a

student I remember thinking do we have

to use the modifier can I just put this

CPT code over here I just that's what I

want to do that's that's what I want to

do just just use that alone but you

can't so why use the modifier well we're

gonna we're gonna touch on three of them

today the 50 modifier which is for a

bilateral procedure and that one you

that one sticks pretty good

it's when you get into the 51 the

multiple procedures

typically people are half and half on

that one and then the Big Daddy of them

all that's 59 that distinct procedural

service that modifier so yeah those are

some of the elephants in the room and

we're just gonna lightly touch on them

today so we we're not gonna get to get

your your feathers all ruffled or

anything but why would you use a

modifier well they're used a CPT

modifiers used to provide further

information about that CPT code and

another thing

modifiers Drive the money particularly

these types of modifiers that 51 and

that 59 so you have to be deliberate you

have to be sure when you are using that

particular modifier so we're going to

talk about it so we're going to stack

them side by side and again if you are

referencing a 50 modifier this would be

the same procedure on both sides of the

body by the same provider so so we're

gonna take this this particular

illustration here the person with the

calves they've got the calf muscles

going on and you see here same procedure

both sides say in the

in this instance if we are coding using

code

27613 with a 50 modifier this is a for a

biopsy of the soft tissue of the leg or

ankle left and right tumors are both

being uh biopsy with the same during the

same session okay so both of these are

three centimeters we need to code for

them the Code 27613 that is coding for

the biopsy but we're going to add that

50 modifier because that's going to let

us know that both sides of the leg was

biopsy so you see how it gives you that

additional information that the code

alone did not give you

so now we take a look at modifier 51.

this is for multiple procedures meaning

two or more and often these are used by

surgeons and doing that same session by

the same provider two procedures were

performed sometimes more that's not

uncommon and you need to capture each of

those procedures that provider needs to

get paid for each thing

we lost you

an actual say a procedure if a patient

came in and the provider took a biopsy

of that soft tissue and after they took

the biopsy they've had that looked at by

someone on their staff and they're like

hey it's still looking kind of funny

then the provider could decide to go in

during that session and say hey we're

going to go ahead and do a radical

resection of that particular tumor of

that soft tissue of the leg so you need

to capture both of those codes okay so

so that's how we would code

27615 for the radical resection and then

we're going to go for that biopsy and

add the 51 that lets the payer know that

hey this provider this surgeon they did

multiple procedures and that 51 lets

them know that it was part of that same

session so that they can be coded for

okay all right so are you guys able to

hear me I see people saying hey we lost

yeah am I back

okay all right so did you lose too much

of it I hope not because I don't know

webinar's been doing some strange things

so so we're back okay all right so I'm

gonna keep going with this one so now we

have modifier 59

and with this one you have two or more

procedures in the same session but the

procedures are distinctly different

distinctly different different site just

two different things going on but the

provider needs to be paid for it so with

a modifier 59 in this case distinctly

different procedure and site or location

so in this instance we're going to be

coding for repair of fascial defect of

the leg

and a biopsy of the soft tissue or of

the leg or ankle so we are using codes

two seven six five six followed by two

seven six one three times two with a 59

okay so I don't know why I put that two

on there okay so with this one we have

two seven six five six and then two

seven six one three is what we would be

coding for okay so one for the biopsy

and repair so those are distinctly

different procedures and then distinctly

different sites you have the leg as well

as the ankle okay

all right

so I think we are good did everybody

hear enough I think some people are

saying hey I think I heard enough so all

right so we're gonna move along with

further talking about modifier 59 that

under certain circumstances it may be

necessary to indicate again that the

procedure of service was distinct or

independent and this is from other

non-em services that were performed on

that day now remember with modifier 59

it is not to be used with e m codes

so the distinction with modifier 59 it

is a different session

a different procedure these are the

circumstances in which they could be

used this this modifier 59 is it a

different session is it a different

procedure

maybe it is a different surgery maybe

it's a different site or organ system

maybe it's a separate incision or

excision maybe there's a separate lesion

maybe a separate injury

and in some cases modifiers to use in

lieu of 59 is x s x p x u and x e and

these will give you more provider

certainty and specificity if it applies

since I think about X you think of

um you think of an extra encounter it'll

be a different encounter if it's XE the

way to remember x s is a different a

separate structure okay separate

structure

that made it distinctly different maybe

it was a different provider okay a

different practitioner XP XU would be an

unusual non-overlapping service or x e

that is a different encounter so these

are more specific modifiers that can be

used in lieu of modifier 59 if if that