You can post a question only up to 7 days from the date of the webinar.
You can continue to post comments and stay informed, compliant, and profitable.
This session has expired.
Register for our upcoming webinars & continue to get coding, compliance & reimbursement updates.


2 Followers Follow
Posted By Maria on 04-16-2019, 14:54:40 in Ob-Gyn

I know CMS has determined that modifier 51 is no longer needed for multiple procedures.

Matter of fact, I think they prefer modifier 51 not to be used.

Their software automatically makes the necessary adjustments.

I realize other payers maybe different, but Medicare is the standard and most bigger payers usually follow their guidelines.

Does modifier 51 actually drive the multiple procedure reduction , or is it Multiple Surgery Indicator on the used CPT codes listed in the Physician Fee Schedule Database? 1,2,3

Their seem to be much confusion on modifier 51 here, stating that is the only way they can determine the RVUs and the reduction is if the coder attaches the modifier 51.

Thus causing provider payment issues as they are paid based on their work RVUs.

This does not seem right to me.

Your opinion please?

Thanks, Maria

Comments (1)
Posted By Melanie Witt on 04-18-2019, 21:50:40
As you say, Medicare no longer requires the -51 because if a second code appears on the claim, they will reduce it according to the multiple surgery indicator. Whether or no commercial insurance insurance does this as well, remains to be seen. But in most cases, I believe they do discount the second, third, fourth, etc. procedures whether -51 is used or not. The most important point here is to always list the code with the highest RVU first on the claim to ensure you get that one paid at 100%.
Do you want to remove this attachment from this post?
Yes No
Do you want to add this specialty to your selected specialty list?
Yes No
To comment, please register for any of our webinars. Click here to register for our upcoming webinars.
This comment will be permanently deleted. Do you still want to continue?
Yes No
Do you want to remove this comment from this discussion?
Yes No
Do you want to block this user from participating in this discussion?
Yes No
Do you want to allow this user to participate in this discussion?
Yes No
This post will not be available for further discussion/comments if deleted. Do you still want to continue?
Yes No