Are you asking about the AAPC study guide?
If so perhaps you should ask them to explain their rationales as CCO can not.
MOHS uses modifier 59 not 51 so that could be the rationale AAPC is using.
Use this page to view details for the Local Coverage Article for billing and coding: mohs micrographic surgery.
www.cms.gov
Free modifier tool from CCO:
CPT Modifier Decision Grid Job Aid Tool:
Click Here to Download
Here is an explanation of modifier 51
Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session. It applies to:
- Different procedures performed at the same session
- A single procedure performed multiple times at different sites
- A single procedure performed multiple times at the same site
Modifier 51 Multiple Procedures indicates that multiple procedures were performed in the same session.
It applies to Different procedures performed in the same session. A single procedure is performed multiple times at different sites.
Diagnostic Imaging Services subject to the Multiple Procedure Payment Reduction that are provided on the same day, during the same session by the same provider.
Note: Medicare doesn’t recommend reporting Modifier 51 on your claim; our processing system will append the modifier to the correct procedure code as appropriate.
Medicare pays for multiple surgeries by ranking from the highest physician fee schedule amount to the lowest physician fee schedule amount.
100% of the highest physician fee schedule amount
50% of the physician fee schedule amount for each of the other codes
Medicare will forward the claim information showing Modifier 51 to the secondary insurance.
Multiple surgery pricing also applies to assistant at surgery services.
Multiple surgery pricing applies to bilateral services (modifier 50) performed on the same day with other procedures.
Modifier is appended when:
The same physician performs more than one surgical service at the same session (Indicator 2).
The technical component of multiple diagnostic procedures, Multiple Procedure Payment Reduction (MPPR) rule applies (Indicator 4).
The multiple surgical procedures are done on same day but billed on two separate claims.
The surgical procedure code is the lower physician fee schedule amount.
The diagnostic imaging procedure with the lower technical component fee schedule amount.
Do not append to add-on codes (See Appendix D of the CPT manual)
Do not report on all lines of service
Do not append when two or more physicians each perform distinctly, different, unrelated surgeries on the same day to the same patient.
Here is an explanation of Modifier 59- Distinct Procedural Service
The CPT Manual defines modifier 59 as follows: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services performed on the same day.
Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.” Don’t use modifiers 59, -X{EPSU} and other NCCI PTP-associated modifiers to bypass an NCCI PTP edit unless the proper criteria for use of the modifiers are met. Medical documentation must satisfy the required criteria
Using modifiers 59 or –XS properly for different anatomic sites during the same encounter only when procedures which aren’t ordinarily performed or encountered on the same day are performed on: • Different organs, or • Different anatomic regions, or • In limited situations on different, non-contiguous lesions in different anatomic regions of the same organ Modifiers 59 or –XS are for surgical procedures, non-surgical therapeutic procedures, or diagnostic procedures that: • Are performed at different anatomic sites, • Aren’t ordinarily performed or encountered on the same day, and • Can’t be described by one of the more specific anatomic NCCI PTP-associated modifiers – that is, RT, LT, E1-E4, FA, F1-F9, TA, T1-T9, LC, LD, RC, LM, or RI.
Only use modifiers 59 or -XE if no other modifier more properly describes the relationship of the 2 procedure codes. Another common use of modifiers 59 or –XE is for surgical procedures, non-surgical therapeutic procedures, or diagnostic procedures that are performed during different patient encounters on the same day that can’t be described by one of the more specific NCCI PTP-associated modifiers – that is, 24, 25, 27, 57, 58, 78, 79, or 91.
https://www.cms.gov/files/document/mln1783722-proper-use-modifiers-59-xepsu.pdf
Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-evaluation and management (E/M) services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.
It is the most reported modifier that affects National Correct Coding Initiative (NCCI) processing.
The Medicare NCCI includes edits that define when two HCPCS / CPT codes should not be reported together.
A correct coding modifier indicator (CCMI) of “0,” indicates the codes should never be reported together by the same provider for the same beneficiary on the same date of service. If they are reported on the same date of service, the column one code is eligible for payment and the column two code is denied.
A CCMI of “1,” indicates the codes may be reported together only in defined circumstances, which are identified on the claim using specific NCCI associated modifiers.
CCMI of "9," NCCI editing does not apply.
This modifier may be reported to indicate that a procedure or service was distinct or independent from other services performed on the same day.
Use when:
A different session
Different procedure or surgery
Different site or organ system: If two procedures are performed at separate anatomical sites or at separate patient encounters on the same date of service separate incision or excision
Separate lesion, or separate injury (or area in injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual
Second initial injection procedure when protocol requires two separate sites or when the patient has to come back for a separately identifiable service
Modifiers XE, XS, XP, and XU give greater reporting specificity in situations where you used modifier 59 previously. Use these modifiers instead of modifier 59 whenever possible. (Only use modifier 59 if no other more specific modifier is appropriate.)
For details, including appropriate and inappropriate uses and examples of modifiers 59 and X(EPSU), please refer to the CMS MLN Fact Sheet,
Proper Use of Modifiers 59 & –X{EPSU}
CMS allows the modifiers 59 or –X{ESPU} on Column One or Column Two codes (see the related transmittal at
CR11168).
Evaluate other anatomical modifir=erssuch as the RT/LT identifying right and left, F1 - F0 to identify fingers, T1-T0 to identify toes and E1-E4 to identify eyelids, coronary arteries modifiers, LC, LD, LM, RC or RI.
Do not use:
When another established more descriptive modifier is available and more appropriate.
When used with an E/M service.
If submitted on E/M codes 99201-99499, E/M codes are processed as though a modifier were not present (i.e., the code pair will be subject to NCCI editing and has an indicator that does not allow bypass).
To report a separate and distinct E/M service with a non-E/M service performed on the same date (refer modifier 25).
When a valid modifier exists to identify the services.
When documentation does not support the separate and distinct status.
When used to indicate multiple administration of injections of the same drug.
When the NCCI tables lists the procedure code pair with a modifier indicator of "0".
Please see this thread on CPT modifiers
CCO Video Modifiers Made Easy: FREE CCO TOOL: https://www.cco.us/cpt-modifier-decision-grid-tool/ 22- Increased Procedural Services 23- Unusual Anesthesia 24- Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative...
www.cco.community
How to code for a MOHS surgery. MOHS is done in stages. MOHS specimens are referred to as blocks. Mohs surgery, also known as chemosurgery is performed to remove complex or ill-defined cutaneous malignancies. 17311 and 17313 are the base codes for the range of this surgery. CPT Code 17312...
www.cco.community
