We are having some discussion about when is a 59 modifier appropriate with multiple FNA specimens, and when can we report multiple units without the modifier. I'm wondering in particular with thyroid and lymph node specimens.
Here is the guidance from CMS: "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."
Would you use a 59 modifier on the second specimen for any of these examples? Assume that all specimens were removed during the same surgical session. Is it "yes," use 59 for all because they are all separate lesions or "no" because they are within the same organ system?
1.
A. right thyroid nodule
B. left thyroid nodule
2.
A. right upper lobe thyroid nodule
B. right lower lobe thyroid nodule
3.
A. right supraclavicular lymph node
B. left supraclavicular lymph node
4.
A. 1st right supraclavicular lymph node
b. 2nd right supraclavicular lymph node
Here is the guidance from CMS: "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."
Would you use a 59 modifier on the second specimen for any of these examples? Assume that all specimens were removed during the same surgical session. Is it "yes," use 59 for all because they are all separate lesions or "no" because they are within the same organ system?
1.
A. right thyroid nodule
B. left thyroid nodule
2.
A. right upper lobe thyroid nodule
B. right lower lobe thyroid nodule
3.
A. right supraclavicular lymph node
B. left supraclavicular lymph node
4.
A. 1st right supraclavicular lymph node
b. 2nd right supraclavicular lymph node