Wiki Using 59 with multiple FNA specimens, 88173

[bbooks]

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

 

[danachock]

Fna

Hi,
I know that there are several times that multiple FNA are done same DOS on different specimens.

If you are coding a FNA for different specimens you will want to use a 59 modifier. Even if you are doing a FNA of Upper left Lobe and Lower Left lobe you will want to use a 59 modifier. Be prepared to appeal.

Reasoning - ok a FNA is done on both upper and lower - if it's benign and you are coding it with the same dx (the dx that was assigned for the procedure to be done) for both - odds are they will deny one as a dupe.

Thanks,
Dana Chock, CPC, CCA, CANPC, CHONC, CPMA, CPB

 

[bbooks]

Reasoning - ok a FNA is done on both upper and lower - if it's benign and you are coding it with the same dx (the dx that was assigned for the procedure to be done) for both - odds are they will deny one as a dupe.

Thanks so much for your input. I don't fully understand what you are saying above. Can you please explain again?

If I am understanding correctly overall, on all of the example I gave, each specimen is from a different site, so we should use 59 modifier for each additional specimen and give each specimen it's own diagnosis code. Am I following correctly?

 

[danachock]

more info

Ok, no worries, let's use the example you provided:
I will provide sample diagnosis codes.

1.
A. right thyroid nodule 241.0 (no modifier; this will be your first listed 88173)
B. left thyroid nodule 241.0 you will use modifier 59

2.
A. right upper lobe thyroid nodule 193 with modifier 59
B. right lower lobe thyroid nodule 193 with modifier 59

3.
A. right supraclavicular lymph node 785.6 with modifier 59
B. left supraclavicular lymph node 785.6 with modifier 59

4.
A. 1st right supraclavicular lymph node 196.0 with modifier 59
b. 2nd right supraclavicular lymph node 196.0 with modifier 59

The same code is being applied for each separate area. When multiples happen like this example they will usually pay for a few and deny the rest as duplicates. Is your system set up to bill out all these charges on the same claim?

This is important. Be sure to appeal. Provide your pathology report along with a brief statement on why you are appealing. I usually start mine with "I am appealing claim(s) 87A87W2111 and 87A869A266 because the pathology report provided by Dr. ABC from our facility supports all the charges we are billing. Please look at the pathology report we have provided and you will see that several different specimens (1A, 1B, 2A, 2B, 3A, 3B & 4A with 4B) were provided by Dr. Black to our pathology department for review."

Please let me know if you need additional information.
Thanks,
Dana

 

[bbooks]

Thanks for such specificity! I should have been more clear - I meant for these examples to be 4 different cases. Still, I can gather from your message that each case should be coded with 88305 and 88305-59. That helps a lot! Thanks.