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Eswl-A patient is under

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119
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Woodbridge, VA
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A patient is under a global period for a Right ESWL. Now she presents for a Left ESWL...which modifier would be the correct one? At the time of the right ESWL, the doctor knew the patient would have to come back to take care of the left ESWL.

Zaida, CPC
 
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4,466
Location
Milwaukee WI
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76

Modifier 76 .... if you are using the exact same CPT code, this indicates a repeat procedure within the global period.

F Tessa Bartels, CPC, CPC-E/M
 

Anna Weaver

True Blue
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769
Location
Kokomo, IN
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Eswl

Modifier 76 .... if you are using the exact same CPT code, this indicates a repeat procedure within the global period.

F Tessa Bartels, CPC, CPC-E/M
But would it be a repeat if it's on the other side? I thought repeats meant that you would be doing exact surgery, exact site? Just asking, cause I'm confused. I was thinking a 58 modifier? If he knew before he went into surgery that he would have to bring her back for the other side?
 

mbort

True Blue
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ENGLEWOOD/DENVER
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exact procedure code is appropriate.

You would not want use the 58 for this scenario. The 58 would only be used if it was a staged/related procedure to the exact site of the primary surgery.

The 76 will bipass the edits as a duplicate and the rt/lt will show the appropriate site. The carrier "should" be able to tell its a repeat procedure and on the other side :)
 

Anna Weaver

True Blue
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769
Location
Kokomo, IN
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eswl

exact procedure code is appropriate.

You would not want use the 58 for this scenario. The 58 would only be used if it was a staged/related procedure to the exact site of the primary surgery.

The 76 will bipass the edits as a duplicate and the rt/lt will show the appropriate site. The carrier "should" be able to tell its a repeat procedure and on the other side :)
Okay, Thanks for explaining, that makes sense now.
 

mbort

True Blue
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2,338
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ENGLEWOOD/DENVER
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Hello,
modifier 59 is mandatory in this case to avoid any confusion.
Why do you feel a 59 modifier is "mandatory"?

There are no other procedures being billed for this DOS therefore I do not feel it is an appropriate modifier for this scenario.

If both the right and left were being performed on the same day, then it would be justified if you were seperating your line items, otherwise the 50 modifier would be used.
 

KCROSS

Networker
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38
Location
Kansas City, MO
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79 is the correct modifier. 76 is repeat procedure on the same day. This procedure is not related to the previous eswl (different stone, different side)
 
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