Wiki Modifier-my CPC certification

[shypes1953@yahoo.com]

I am brand new at coding. I just got my CPC certification as apprentice status. I noticed on one post that a coder wanted to know if they would use modifier 59 or 76 on excision of two different lesions measuring the same using CPT 11642. Additional post was to append modifier 59. I have noticed coders from our hospital use modifier 51. Which is correct?

 

[hopepg]

I don't see a CMS CCI edit that would bundle that code if billed twice, so I would think modifier 59 is the wrong mod to use. I'd think 51 is more appropriate...but I guess see if anyone else replies that has specific experience with this...

 

[mitchellde]

If you have two lesions each coded with a 11642 then your claim will look like this with no modifiers
11642
11642
the edits will cause the second line item to reject as a duplicate. The 51 modifier will not stop this edit from occurring. The 51 modifier says that the second procedure is performed in the same session as the first. There are numerous payers that no longer use the 51 modifier as its only purpose is to allow for the discounting of the second procedure. When two procedures are performed in the same session , then the second procedure is discounted as the prep is not repeated for the second procedure and they carve it out of (discount) the second procedure.
The 76 modifier is for a repeat procedure, which is exactly the same procedure repeated in a different session. First, a different excision is not a repeated procedure as it is performed on a different area, and second, it is not performed in a different session. The 76 modifier bypasses the discounting. An example of a repeated procedure would be a repeated EKG.
The 59 modifier is for distinct procedure, and is for a second procedure that is performed not as a component, but as a separate entity and can be supported with the logic of separate site, separate incision or separate body part.
So when you have 2 excisions that can be coded with the same CPT code, then to keep the edit from disallowing the second procedure, you need the 59 modifier to show distinct and separate procedure.
11642
11642 59 51 (51 would be second listed but with most payers not needed)

 

[shypes1953@yahoo.com]

Cpc-a

Thank you so much. Since I have just started in coding, I appreciate this forum and all your help.