Modifier 51 | Multiple Procedures Explained

Modifier 51 describes the use of multiple procedures during the same patient encounter. In this article, we will explain modifier 51, including its definition, appropriate usage, documentation requirements, billing guidelines, common mistakes, related modifiers, and additional tips for medical coders.

1. What is modifier 51?

Modifier 51 is a CPT® modifier used to indicate that multiple procedures were performed by the same provider on the same patient during the same encounter. It informs the payer that the provider performed multiple procedures in the same operative session.

2. When to use modifier 51?

Modifier 51 is used when the same provider performs multiple procedures for the same patient during the same encounter.

Examples of using modifier 51 include the provider performing the same procedure on different anatomic sites, the provider performing different related procedures on the same anatomic site, or the provider performing the same procedure on the same anatomic site multiple times.

3. Description

The official description of modifier 51 is “multiple procedures.”

When multiple procedures, other than E/M services, physical medicine, and rehabilitation services or supplies, are performed at the same session by the same individual, 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).

4. Examples

Examples of procedures that require modifier 51 include a surgeon performing a hernia repair and a cholecystectomy during the same operative session, a dermatologist removing multiple skin lesions during the same encounter, or a gastroenterologist performing a colonoscopy with biopsy and a polypectomy during the same encounter.

5. Documentation

Documentation requirements for using modifier 51 include a clear description of each procedure performed, the anatomic site of each procedure, and the reason for performing each procedure.

The documentation should also include the start and stop times for each procedure and any complications that occurred during the procedure.

6. Billing

When billing for multiple procedures, append modifier 51 to the subsequent procedures performed by the same provider during the same encounter.

Be sure to report the most complex procedure, the claim form, for the highest dollar amount.

Some payers typically reimburse the most for the most expensive procedure and will reduce payment for subsequent procedures with lower charges that you report with modifier 51.

7. Common mistakes

Common mistakes that medical coders make when using modifier 51 include using it with modifier 50, with add–on codes, with codes that are modifier 51 exempt, or with bilateral procedures. It is also essential not to use modifier 51 with E/M services, physical medicine,e and rehabilitation services or supplies.

8. Other modifiers related to modifier 51

Other modifiers related to modifier 51 include modifier 50, used to indicate a bilateral procedure, and modifier 59, used to indicate a distinct procedural service.

9. Tips

When submitting claims electronically, Medicare does not want you to use modifier 51. However, some smaller payers may require the use of this modifier.

Before submitting your claim, you should contact your insurance carrier and ask which method you prefer when reporting multiple surgical procedures.