Gastroenterology Coding Alert

Use mod -59 when coding procedures not normally reporting together When your gastroenterologist performs two procedures from the same endoscopic family, do you always report only one code? If the gastroenterologist performs two surgeries on the same day, do you assume that the lesser procedure isn't reportable? If you answered "yes" to either of these questions, you may not be taking advantage of all the situations when you can use modifiers -59 and -51. Read on for more information on these modifiers to help you when reporting related codes on the same claim. Use Mod -59 When Codes Are Close Gastroenterology coders use modifier -59 (Distinct procedural service) to identify procedures that are distinctly separate from any other procedure or service the physician provides on the same date.

In general, coders append modifier -59 to procedure codes when the physician:
  sees a patient during a different session; treats a different site or organ system; or treats a separate injury. In gastro offices, this modifier "is not usually used during office visits," says Linda Parks, MA, CPC, CMC, CCP, coding specialist at GI Diagnostics Endoscopy Center in Marietta, Ga. "It's used when multiple procedures in the same endoscopic family are performed at the same time."

Example 1: Let's say the gastroenterologist performs a colonoscopy with a cold biopsy and removes a separate polyp via snare technique. You should: report 45385 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s] or other lesion[s] by snare technique) attach modifier -59 to CPT 45380 ( ... with biopsy, single or multiple). The modifier shows the carrier there were two different sites treated. "If these codes were billed without a modifier, 45380 could be bundled into 45385 [by the insurance carrier]," Parks says.

Example 2: The gastroenterologist performs an upper gastrointestinal endoscopy (EGD) with balloon dilation of the esophageal stricture and an EGD with biopsy of a gastric ulcer.

You should: report 43249 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with balloon dilation of esophagus [less than 30 mm diameter]) attach modifier -59 to 43239 ( ... with biopsy, single or multiple). The modifier shows the carrier there were two different procedures performed, even though they were both EGDs. Pay Attention to Code Order Make sure you know which code you are attaching modifier -59 to, or you could lose out on money. "The modifier should always be placed on the code with the lower RVU [relative value unit], or the code that will be denied to National Correct Coding Initiative (NCCI) edits," Parks says.