Wiki Modifer 59

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cmblocher

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I am trying to learn when to use modifer 59 on S&I codes. I am struggling.
Here are the codes I have selected:
36247 (SFA Cath)
36248 (Popliteal Cath)
35474 (PTA SFA)
75630-26 (Aortogram-bilateral illiac run-off)
75774-26 (external iliac)
75774-26 (SFA)
75774-26 (Popliteal)
75962-26 (PTA S&I)

Any help would be very much appreciated.
 
would you have a copy of the report that I could see? I don't see anything that would need a 59 mod. with these codes. Either a 76 or 59 on the additional 75774's depending on the payer though...
 
Could you give me an example of when it would be necessary to use modifer 59? Thanks for looking at this note.

OPERATION: Right superficial femoral artery percutaneous
transluminal angioplasty (PTA) with a cutting balloon.

ANESTHESIA: Local with sedation.

PROCEDURE: The patient was placed in the supine position on the
operating table. The area was prepared and draped in the
appropriate manner. Local infiltration was carried out.
Percutaneous entry into the left femoral artery was accomplished.
The guidewire and sheath were inserted. A retrograde aortogram was
done showing a normal distal aorta and iliac runoff. The catheter
was passed over the aortic bifurcation down into the external iliac
on the right side, where an angiogram was performed of the right
groin. This showed a patent superficial femoral artery and profunda
with 2 visible stents in the proximal superficial femoral artery.
The catheter was then passed down through the stents and into the
superficial femoral artery just distal to the stents. Further
angiography was done showing some irregularity, but no significant
narrowing in the superficial femoral artery. The catheter was
passed down into the popliteal. Further angiography showed again a
narrowing in the popliteal, but this did not appear to be
hemodynamically significant. There was no hold up in dye. The
anterior tibial and peroneal were open down to and into the foot.
The posterior tibial was hardly visible and had significant disease
within it. It was only intermittently open down to the ankle. It
was felt that nothing could be done in the posterior tibial. The
sheath was exchanged, and the cutting balloon was advanced into the
area of stenosis within the previously placed stents. This was then
blown up to appropriate pressures in the 2 areas of stenoses within
the stents. A followup angiogram showed an excellent result, and it
was felt that nothing further needed to be done. The sheath was
then pulled back. An angiogram showed that the sheath was entering
just at the takeoff of the profunda femoris artery. For this
reason, a Mynx hemostatic device was used for hemostasis in the left
femoral artery. Hemostasis was quite good after deploying the Mynx
device. The wound was covered with a sterile dressing, and the
patient was taken to the recovery room in satisfactory condition
having tolerated the procedure well.
 
Looking at this note, I would definitely do the 36247-51, but I don't think that I would do the 36248. The cath. was passed down through the SFA and into the Popliteal which would be your 3rd order selection. The Popliteal would be the final catheter destination. I added the 51 onto the 36247 since you also have the 35474 with a higher RVU value.
 
36247-51(36247 and 35474 are multiple procedure we have to give 51 with the lower RVU)
35474
75625
75710-59(75710 is a component of 75962 so we have to give 59 mod)
75962

Hi i think these are the codes for the report, i dont no if 75774 will come thrice
 
Last edited:
My first impression on the codes when I looked at the report were this:

75625
75710-59
36247-51
75962
35474
I was thinking of one 75774 for the final popliteal catheter placement. It was an additional vessel after the main study (aortogram/run-off)
 
I choose 36247, 36248. Because the surgeon started in the left femoral, and advanced past the bifurcation and into the right side, and then into the external iliac. He then advanced into the SFA and Popliteal. I don't see how this is all covered in 36247?

I agree with 75625. 75710. There were also seperate angiograms done in the SFA, and Popliteal.Would this not be coded with additional 75774 X2?

I thought that I understood caths/angio's. I obviously have no idea what I am doing.
 
since the popliteal is an extension off of the SFA, I would only code to highest "stopping" point which would be the popliteal (36247) The angiograms in the arteries along the way would be included in the 75710 (lower extremity run-off). At least that would be my understanding.
 
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