CPT modifiers 50 , 53 & 51 Mulitiple procedures

Mar 7, 2010 | Medical billing basics

Medicare Part B modifiers – 50


Bilateral Procedure: unless otherwise identified in the listings, bilateral procedures
that are performed at the same operative session should be identified by adding the
modifier 50 to the appropriate five digit code.

Report such procedures as a single line item with a unit of 1. For example, when
procedure code 19180 ( Mastectomy, simple, complete) is performed bilaterally,
report the service as 1918050.

If a procedure is identified by the terminology as bilateral ( or unilateral or
bilateral), do NOT report the procedure code with modifier 50. For example,
procedure code 68810 to 68815, ( probing of nasolacrimal duct, with or without
irrigation, unilateral or bilateral) includes terminology which indicates the
procedure is performed either unilaterally or bilaterally. Therefore it’s not
appropriate to report this modifier with this code.

Additionally some procedure codes, i.e., 52000 ( Cystourethroscopy, separate

procedure) should NOT be reported with the 50 modifier since anatomy does not
permit this procedure to be performed bilaterally.

Medicare Part B modifiers – 53 Discontinued Procedure:
Under certain circumstances, the physician may elect to
terminate a surgical or diagnostic procedure. Due to extenuating circumstances or
those that threaten the well being of the patient, it may be necessary to indicate that a
surgical or diagnostic procedure was started but discontinued. This circumstance may
be reported by adding the modifier 53 to the code reported by the physician for the
discontinued procedure.

Use modifier 53 (discontinued procedure) to report a failed or terminated colonoscopy,
or a failed or discontinued procedure. Documentation describing the circumstances
requiring the discontinuation of a procedure should be provided with the claim
submission. If this information is NOT included, your claim may be denied.

Note: This modifier is not used to report the elective cancellation of a procedure prior to the
patient’s anesthesia induction and/or surgical preparation in the operating suite. For
outpatient hospital/ambulatory surgery center (ASC) reporting of a previously scheduled
procedure/service that is partially reduced or cancelled as a result of extenuating
circumstances or those that threaten the well being of the patient prior to or after
administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC
hospital outpatient use).

Medicare Part B modifiers – 51 Multiple Procedures:

When multiple procedures, other than evaluation and management services, are performed at the same session by the same provider, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending the modifier 51 to the additional procedure or service code(s). Note: This modifier should not be appended to designated “add-on” codes (e.g., 22612, 22614).

CPT modifiers for surgery global period
Anesthesia billing modifiers
ASC modifiers
What is modifiers

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