Modifier 51 Underpayment and Medicare
Single Line Modifier 51 Underpayment
Multiple surgeries are separate procedures performed on the same patient at the same operative session or on the same day for which separate payment may be allowed. When multiple surgical procedures are performed, Medicare Physician Fee Schedule (MPFS) rules state that the second and any subsequent procedures are subject to reduced reimbursement i.e. modifier 51 underpayment. Providers are instructed to report modifier 51 (multiple procedures) to identify such services.
When only one surgical procedure is performed and modifier 51 is claimed, the reimbursement is inappropriately reduced by 50%. This concept was identified as a result of research and data analysis of the Centers for Medicare & Medicaid Services (CMS) Part B Policy for CPT Surgery: codes 10021 to 69990.
Examples of Modifier 51 Underpayment
Physician billed one procedure with Healthcare Common Procedural Coding System (HCPCS) code 36475 (Endovenous ablation therapy of incompetent vein, extremity, and modifier 51 (Multiple Procedures) for date of service 8/3/2010. No other physician services were billed for this date of service.
The billing error resulted in an underpayment of $669.25.
Physician billed one procedure with HCPCS code 47120 (Partial removal of liver) and modifier 51 (Multiple Procedures) for date of service 06/25/2012. No other physician services were billed for this date of service.
The billing error resulted in an underpayment of $1,230.47.
How Providers Can Avoid These Problems
Providers and their billing representatives must use caution when using modifier 51. It is inappropriate to use multiple procedure modifiers, when there is no second procedure performed. Review the resources listed below to better understand the billing regulations.
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Not only does the 51 modifier allow us to code physician services to the highest level of specificity possible, but it ensures the physician is paid accordingly for those services. However, it’s important to stay aware of the most current payer guidelines for appending modifiers, particularly modifier 51. Still not sure about the appropriate use of Modifier 51? Don’t worry E2E Medical Billing Services has an experienced coding team that uses exact modifiers to avoid denials. To know more about our medical billing services call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com