Wiki Modifier 50 and which code to append to?

[lpalladino]

My provider writes this on his note:
The Right L3/L4, L4/L5 and Bilateral L5/S1neural foramen was identified using fluoroscopic guidance after which the overlying skin was anesthetized utilizing sterile technique with preservative free Xylocaine.

CPT codes 64483,64484,64484 - Which codes does the 50 modifier append to?

 

[Orthocoderpgu]

64483-RT (L3/L4)
64484-RT (L4/L5)
64484-50-59 (L5/S1)

 

[lpalladino]

64483-RT (L3/L4)
64484-RT (L4/L5)
64484-50-59 (L5/S1)

Can you explain why on the 64484 and not the 64483. My provider would like an explanation as to why we cannot append to the 64483 (prime code) - and what does the -59 modifier do for us?

 

[Orthocoderpgu]

According to the physician's documentation the procedure was performed on the right side at the L3/L4 level and the L4/L5 level. It's not until the L5/S1 does the documentation state "bilateral". The -59 modifier is used to show that the procedure was performed at a different "level" and is not bundled with the first 64484. Without it the insurance would deny the L5/S1 procedure with L4/L5 procedure. You can't append -50 on 64483 because the documentation states that the injection was given on the right, not bilaterally.