AMA CPT® Assistant - 2008 Issue 7 (July)
Modifier 51 Exempt Codes and Appendix E (July 2008)
July 2008 pages 7-8 Coding Communication: Modifier 51 Exempt Codes and Appendix E CPT 2008 contains revisions to the definition of modifier 51 and Appendix E. These revisions were made after a joint work group of the CPT Editorial Panel and the Resource Based Relative Value System Update Committee (AMA RUC) reviewed the criteria for inclusion in Appendix E. In this article, we seek to give insight into the review process that the joint committee and the Panel undertook in these revisions and to also explain the process for codes to become designated as modifier 51 exempt. We will...
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Article Overview
This July 2008 CPT coding communication covers the background and review framework for modifier 51 and Appendix E. It is aimed at coders, compliance staff, and reimbursement professionals who need to understand how CPT and the AMA RUC evaluate services for modifier 51 exemption, what categories of guidance are considered, and how new or existing codes may be reviewed for Appendix E placement. The article also includes a worked example showing how the process is applied to a specific CPT service and references related CPT section guidance, surgical package concepts, and multiple procedure reduction policies.
Why This Topic Matters
Understanding modifier 51 exemption status is important because it affects how multiple procedures are reported and how payer reductions may apply. The article helps readers interpret CPT’s framework for services that are treated differently under multiple procedure payment policy.
Article Sections
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July 2008 pages 7-8
Introductory coding communication describing the July 2008 CPT update and the topics covered in the article.
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Modifier 51, surgical package, and RVU context
Background on modifier 51, its relationship to surgical package concepts, and the broader payment-policy context for overlapping services.
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Modifier 51 exempt services and Appendix E
Overview of why certain procedures may be treated differently from other services and how CPT’s Appendix E is used in that context.
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Criteria for Appendix E placement
Summary of the general factors reviewed when determining whether a service belongs on the modifier 51 exempt list.
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Process for adding or retaining codes in Appendix E
Discussion of how code change proposals are reviewed and how CPT and the RUC coordinate on Appendix E placement.
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Example: Code 94610
A worked example illustrating the review process for a specific CPT service, including related vignette and service description material.
What You Will Learn
- The purpose and role of modifier 51 within CPT guidance
- How Appendix E relates to modifier 51 exemption status
- What general criteria are considered in reviewing services for the exempt list
- How CPT and the AMA RUC participate in the review process
- How the article’s example illustrates the Appendix E process
Who Should Read This
- Medical coders
- Coding educators
- Revenue cycle professionals
- Compliance teams
- Physician practice billing staff
- Hospital coding staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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