General Surgery Coding Alert

Question: When I code for a bilateral mastectomy, I use modifier 50. But in some cases the mastectomy done on each side is different so the bilateral goes out the door. I am coding for a modified radical 19307 on the left and a simple 19303 on the right. Do I use a modifier 51 or modifier 59 for the second procedure?

Minnesota Subscriber

Answer: Modifier 59 (Distinct procedural service) is the modifier that will help you out here because it tells the payer that the procedure was performed in a different location (the other breast).

You will definitely need the modifier to get paid for both of these procedures. If you don't add a modifier the payer will assume that the surgeon started with a simple mastectomy and then found more extensive disease and did a modified radical mastectomy on the same breast.

Remember that you should use modifier 59 only in three circumstances:

• When the surgeon performed the procedure in another location

• When the surgeon performed the procedure at a different session (another time on the same date)

• When the procedure was a diagnostic procedure that lead to the decision to perform a therapeutic procedure.

Applying these concepts to a situation will always tell you if you can bill separately using modifier 59 to justify the unbundled service.

Keep in mind: Modifier 51 (Multiple procedures) would only indicate that the multiple procedure discount should be applied to the procedure, so that wouldn't help.