Wiki Mod - 50: please help settle a disagreement

[MnTwins29]

A physician has been sending superbills for thyroid biopsies with modifier -50 because he has taken samples from both the left and right side. I say that this cannot have modifier -50 because the thyroid is not a paired organ - there is only one thyroid gland. Who, if either of us, is correct?

 

[Walker22]

What is the CPT code? I can use the RBRVS to see if a bilat modifier is allowed.

 

[MnTwins29]

CPT code

60100 - did this on both sides. Thank you.

 

[slrollings]

You are correct. The body does not have a right and left thyroid gland, so you should not use the -50. It would be x2.

 

[Walker22]

According to the RBRVS, 60100 is not eligible for mod-50.

 

[Lisa Bledsoe]

I would code 60100 and 60100-59 since the biopsies are from different sites of the thyroid gland.

 

[djr5958@hotmail.com]

Modifier 51 instead of 59 in this instance.

I believe modifier -51 is better that -59 in this instance since the procedure is done on the 'same session , same provider' and same approach. Modifier -59 is for a distinct service, 'independent from other services performed on the same day'. For this I looked up the Appendix A in the CPT book.
I hope this is helpful to you.

 

[Walker22]

I have to disagree. Modifier 59 is the appropriate modifier to use. You must differentiate between the two different biopsies. If you don't use mod-59, then the two biopsies will get bundled together and you will only get paid for one of them.

 

[Lisa Bledsoe]

I believe modifier -51 is better that -59 in this instance since the procedure is done on the 'same session , same provider' and same approach. Modifier -59 is for a distinct service, 'independent from other services performed on the same day'. For this I looked up the Appendix A in the CPT book.
I hope this is helpful to you.

Mod -59 is the appropriate modifier for "separate biopsies".

 

[dballard2004]

I would report mod -59 as well. These are separate and distinct procedures.

 

[MnTwins29]

Thanks, everyone.

Not only did you confirm that I was correct about -50, but it also verified that my suggestion to the doctor to use -59 was right as well.