When billing for multiple procedures on the same day, use this step by step procedure to determine if you should bill for more than one procedure, and if so, if you should use modifier 51 or modifier 59. It is critical to have access to National Correct Coding Initiative ((NCCI) edits in your software program.  The NCCI edits are developed by Medicare. They include services that are mutually exclusive, medically unlikely edits, and procedure-to-procedure edits, commonly called bundling edits.

In some groups, the coder performs all of the steps below. The responsibilities indicated here are my opinion, and not law, regulation, or national policy.

Physician Responsibility or Coder Determined from Report for multiple surgical procedures

1. List all codes for the procedures performed; in some cases a coder does this.
2. Note whether the procedures performed were done via the same compartment, incision, site, organ system, lesion, injury, session and by the same surgeon. If all are the same, note “same.” If any of the above were different, note “different”.