Wiki Hospital Radiology billing CT Facial 70486 with CT Sinus 70486 MOD 59

[MRKOCUREK]

Here is the scenario. The doctor ordered 2 orders for 2 separate procedures:

1) CT sinuses for ethmoid sinusitis
2) CT Facial for R/O fracture of Left Mandible

Both scans are different because of the patient history. Radiology department was simply doing what was ordered by the physician. This is an outpatient procedure. Only problem I see with billing both of these is that they share the same cpt 70486. In fact this cpt includes the sinus, but not as detailed as the one done here
. Do you think we can put a modifier 59 to distinguish between the 2. Please help.

Thank you

 

[jgf-CPC]

59 mod

To me it's like us doing the IAC's and the brain (both a 70551-70553)....we add the 59 mod and hope it gets paid...hope that helps....just make sure you have your separate reports for back-up or appeals

 

[MRKOCUREK]

59 Mod

Yes, true in your case, but 70486 includes the sinus. Im not sure we would be in compliant using this code twice when this one code included it all

 

[jgf-CPC]

70486

True, when we do the IAC's we do extra cuts (more than further sequences) which are normally included in the brain. I guess you would have to make that decision and I guess I could not help you. Sorry.