Wiki modifier 59

[kellyal]

Is it appropriate to use the 59 modifier on procedure code 64472 when also billing procedure code 64470? If not and you are billing 2 units for 64472 because there are two additional levels how would you bill this? Any help is appreciated.

Kelly A

 

[mbort]

Is it appropriate to use the 59 modifier on procedure code 64472 when also billing procedure code 64470? If not and you are billing 2 units for 64472 because there are two additional levels how would you bill this? Any help is appreciated.

Kelly A

The 59 would not be appropriate if you are just billing as follows
64470
64472

If you have two additional levels, then DEPENDING ON THE INSURANCE CARRIER AND WHOM YOU ARE BILLING FOR (dr, ASC, etc) can be done one of two ways
64470
64472 x 2 units

or

64470
64472
64472-59

 

[magnolia1]

When I code these cases, I use Mary's second scenario with anatomical modifiers only. You don't need the "59".

 

[mitchellde]

Per the CMS 1500 billing manual, it is not appropriate to use units when billing except for services that are identified as a quantity such as drugs and timed services, surgical procedures may not be billed with units. Each procedure is performed at a distinct and separate site and therefore we need to have a line item on the claim for each distinct and separate procedure. If the 64470 is bilateral the use the 50 modifier or with some payers the RT, with one line item and the LT with the other. If 3 separate levels are identified in the documentation the the appropriate listing is the
64470
64472
64472 59
I hopoe this helps to clarify as this will allow for optimal reimbursement of the claim.
Debra Mitchell, MSPH, CPC-H