Modifier 59 versus LT and RT to Unbundle

JBowyer

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We have a dispute regarding whether to use modifier 59 or modifier 51 with LT and RT. We have two urology procedures performed in same operative session that are bundled, but a modifier is allowed. 50590 on the left and 52356 on the right. We have three opinions. #1 50590-LT; 52356-59, RT #2 50590-LT; 52356-51,RT #3 50590; 52356-59

One brought the example below:
Example 6: Column 1 Code / Column 2 Code - 29827/29820

>CPT Code 29827 – Arthroscopy, shoulder, surgical; with rotator cuff repair
>CPT Code 29820 – Arthroscopy, shoulder, surgical; synovectomy, partial

CPT code 29820 should not be reported and modifier 59 should not be used if both
procedures are performed on the same shoulder during the same operative session because
the shoulder joint is a single anatomic structure. If the procedures are performed on
different shoulders, modifiers RT and LT should be used, not modifier 59.


LT and RT have not effect on the actual processing of the claim for payment, because they are informational. Correct?
Can you help us?

Thanks,
Urology Group
 

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When it comes to LT/RT and 59, this is the information I have:

"Modifier 59 Distinct procedural service.
The NCCI Policy Manual reiterates the CPT codebook’s definition: 'Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.
Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.' If one of the specific anatomic modifiers (RT, LT, E1-E4, etc) may be assigned, it should be used instead of modifier 59."

RT and LT are not informational modifiers; they're actually the equivalent to a 59. Technically, if you have an RT and an LT, the 59 shouldn't be needed. "Technically" :rolleyes:

With regards to the 51 mod, my understanding is that many payers follow Medicare when reporting it. My local MAC states "Medicare does not recommend reporting Modifier 51 on your claim; the processing system has hard-coded logic to append the modifier to the correct procedure code."

If it were me, I would bill it as:
50590-LT
52356-RT

If it denies incorrectly for bundling, and there's a good chance it will, then I'd tack on the 59 as previously mentioned. At least I can say I tried to follow the rules.
 
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Use "XX" modifiers

The "XS" modifier would apply.
I would bill:
50590-LT
52356-XS,RT
This tells your payor the 52356 was for a separate structure/organ.
Julie Ordway, CPC
 
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