Modifier 59 and 51. Do we need both?

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November 1, 2018

Question:
Should we append both 59 and 51 when a code is bundled and is also a subsequent procedure?

Answer:
Modifier 59 is only used if two codes are bundled, specifically if there is a NCCI edits for the two codes. If there is no edit, a modifier 51 is used.  Over-use of modifier 59 is an audit target, so its use should be reserved for this scenario.

And when modifier 59 is used appropriately, a modifier 51 is redundant and unnecessary. Modifier 59 is always placed on a subsequent, lower valued code negating the need for modifier 51.

*This response is based on the best information available as of 11/01/18.

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