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Oncology & Hematology Coding Alert

Reader Questions:

Modify Less Extensive Code With -59

Published on Mon Jun 20, 2005

Question: I know that I can use modifier -59 to unbundle codes under the right circumstances, but which code should I attach it to?

New Jersey Subscriber Answer: You should always append modifier -59 (Distinct procedural service) to the lesser-valued (column 2) code - regardless of the order in which the doctor performed the procedures.
 
Example: The latest NCCI edits bundle 76986 (Ultrasonic guidance, intraoperative) into 78804 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; whole body, requiring two or more days imaging). If you genuinely have two distinct services (separate anatomic sites or different patient encounters) and want to unbundle these two procedures, report 78804 (which usually pays about   $400-500) and 76986-59 (which pays about $150).  
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