Which Modifier

medmgtalt

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If you do a colonoscopy and an egd at the same visit, do you use a -51 or a -59?:)
 

kim cpc

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RE: modifier

You'd code the colonoscopy as the first procedure and the egd as second procedure on the egd you'd add the TA with mod 51.

Example:

45378
43239,TA 51
 

kusuma

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Modifier 59/51

Hi,

As far as my understanding goes it should be reported using a modifier 51 and not 59. As it says do not use modifier 59 when there is an alternative modifier that can explain the scenario.
 

Lisa Bledsoe

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There are some that say no modifier and they get paid for both...but in our practice we use -59 on the EGD. Use -59 because of they are separate procedures (different entrance locations obviously).
 

mbort

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the TA modifier is not appropriate as that is for the Left Toe..since we are talking EGD and Colonoscopies..for obvious reasons you would not use it.

As far as the 59 goes, in normal instances it is should not be necessary however you will find some carriers have there own opinions and will want it. Its important to know the carrier idiosyncrasies (thank you Tessa)
 
Last edited:

elenax

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I don't use neither one and I get paid anyway. I think they don't need the modifier because both procedure are self explanatory indicating different anatomical sites. I work for an ASC though...
 

ncantello

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Which modifiers would you use if physician performs 45385 and 45380? Would it be inappropriate to use -59 here? Should -51 be used instead?
 

maysons1703

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Why wouldn't you code both? The use of both modifiers indcate that multiple procedures were performed due to seperate conditions.
45380
45385-51-59
 

Lisa Bledsoe

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Why wouldn't you code both? The use of both modifiers indcate that multiple procedures were performed due to seperate conditions.
45380
45385-51-59
You use -59 because it is a separate lesion/polyp. 51 would indicate that you did a bx and a polypectomy on the same polyp, in which case you would only get paid for one procedure. Also, CCI edits state -59.
 

aguelfi

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If you are using 45380 amd 45385 your documentation better support that these were done in different locations otherwise 45380 is included in 45385.
And I never use a modifier on an EGD and Colonoscopy and I always get paid.
 

scorrado

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I dont use a modifier either when I code an EGD and colo. Never had any issues with payment. I believe the procedure codes themselves tell the insurance company that they are "distinct procedural services". They are obviously done from different "openings" and the majority of the time you will probably be using a different diagnosis.
 
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