by Paula Anderson
As a medical coder and/or medical biller, the application of CPT ® and HCPCS modifiers are key to ensuring proper claim reimbursement. Let’s discuss a few surgery modifiers:
According to the 2024 CPT ® Professional Edition, modifier 51 is for Multiple Procedures (Appendix A) and modifier 59 is for Distinct Procedural Service.
Artwork: PACC staff
This modifier is used when two related procedures are performed during the same encounter. The first procedure will be billed at 100 percent and the second procedure will be billed at 50 percent. The procedure with the highest relative value unit (RVU) should be listed as the first item on the claim form in Block 24D.
Modifier 59 is Distinct Procedural Service. This modifier is often misapplied based on the understanding of a distinct procedure. When applying this modifier, make sure that documentation supports the correct usage. The HCPCS modifiers - XP, XE, XS and XU give more descriptive reasons for using M59.
Before applying modifiers, make sure the documentation supports it. Also, check the payer policy regarding modifiers.
To learn more about modifiers, sign-up for our continuing education course.
Source: 2024 CPT ® Manual Professional Edition
Paula Anderson is a certified professional coder and approved instructor with AAPC. She has over 25+ years of teaching experience.
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