Wiki multiple surgery with modifier

[ttmidas]

I'm trying to determine whether or not it would be appropriate to use a modifier in this case. A laparoscopic pelvic lymphadenectomy (cpt 38571) and laparoscopic appendectomy (cpt 44970) were done at the same session. CCI edit shows bundled, but can be billed with modifier. Even though these are two separate organ systems and not contiguous structures, is it being considered same site because it's in the pelvic area? Laparoscopic hysterctomy (cpt58552) also hits up against the edit with appendectomy, but not with the pelvic lymphadenectomy.

thanks

 

[RGALVEZ]

A modifier 59 is allowable on 44970 when billed with 38571, according to the McKesson CCI edit tool. Having said that, as you know, the documentation has to support the use of modifier 59. Here is the link should you want to use the site for this or other coding issues. This is from the BCBS of Tx web site:

http://www.bcbstx.com/provider/clear_claim_connection.htm

Hope this helps.

 

[FTessaBartels]

+44955

For the appy you should be using the add-on code +44955. This code is valid whether the procedure was done open or laparoscopically.

HOWEVER ... you have to have an indicated purpose for the appy. It has to have been symptomatic, or obviously inflamed. If it was done because you were "in the neighborhood" it is NOT billable.

Hope that helps.

F Tessa Bartels, CPC, CEMC