upper and lower GI w/ mod 59

Miagirl78

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When billing an upper and lower GI, using cpt codes 45378 and 43235, is it appropriate to append a modifier 59 to 43235?
 

mitchellde

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when the code descriptors already identify the procedures as distinct and separate from one another there is no need or requirement for the 59. So when one procedure indicates a different orifice from the other then there is no reason to use the 59 to indicate distinct and separate.
 

coachlang3

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Don't need to.

You may need a 51 modifier to show multiple procedures but many payors have done away with needing them (medicare has specifically stated to not use the 51 as their system does it for them/you).

The 59 modifier is used to show codes normally done at the same time (45380 and a 45385) are done at the same time but there is a reason you did them and need to be reimbursed for that service, (ie a polyp in the ascending colon is snared and a polyp in the sigmoid colon is cold biopsied).

You should check the NCCI bundling edits.
 
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