June 24, 2021

Question:
The neurosurgeon performed an ACDF and then also did a carpal tunnel decompression at the same time.  When we were paid by insurance, they paid us half of the allowable for the carpal tunnel procedure code.  Is that correct?  Should we have billed the carpal tunnel Surgery (64721) with modifier 59 so the reduction wouldn’t be taken?

Answer:
From a payor standpoint, the modifier 51 reduction is taken because of overlapping pre and postop care.  You didn’t do two preop H&Ps, one for the ACDF and one for the carpal tunnel procedure, and you aren’t seeing the patient back for double the number of postop visits.  You would still receive a reduced payment using modifier 59. So you were correct to use modifier 51 (multiple procedures).

*This response is based on the best information available as of 6/24/21.