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Modifer 59

  1. #1
    Unhappy Modifer 59
    Medical Coding Books
    I am trying to learn when to use modifer 59 on S&I codes. I am struggling.
    Here are the codes I have selected:
    36247 (SFA Cath)
    36248 (Popliteal Cath)
    35474 (PTA SFA)
    75630-26 (Aortogram-bilateral illiac run-off)
    75774-26 (external iliac)
    75774-26 (SFA)
    75774-26 (Popliteal)
    75962-26 (PTA S&I)

    Any help would be very much appreciated.

  2. #2
    would you have a copy of the report that I could see? I don't see anything that would need a 59 mod. with these codes. Either a 76 or 59 on the additional 75774's depending on the payer though...

  3. #3
    Could you give me an example of when it would be necessary to use modifer 59? Thanks for looking at this note.

    OPERATION: Right superficial femoral artery percutaneous
    transluminal angioplasty (PTA) with a cutting balloon.

    ANESTHESIA: Local with sedation.

    PROCEDURE: The patient was placed in the supine position on the
    operating table. The area was prepared and draped in the
    appropriate manner. Local infiltration was carried out.
    Percutaneous entry into the left femoral artery was accomplished.
    The guidewire and sheath were inserted. A retrograde aortogram was
    done showing a normal distal aorta and iliac runoff. The catheter
    was passed over the aortic bifurcation down into the external iliac
    on the right side, where an angiogram was performed of the right
    groin. This showed a patent superficial femoral artery and profunda
    with 2 visible stents in the proximal superficial femoral artery.
    The catheter was then passed down through the stents and into the
    superficial femoral artery just distal to the stents. Further
    angiography was done showing some irregularity, but no significant
    narrowing in the superficial femoral artery. The catheter was
    passed down into the popliteal. Further angiography showed again a
    narrowing in the popliteal, but this did not appear to be
    hemodynamically significant. There was no hold up in dye. The
    anterior tibial and peroneal were open down to and into the foot.
    The posterior tibial was hardly visible and had significant disease
    within it. It was only intermittently open down to the ankle. It
    was felt that nothing could be done in the posterior tibial. The
    sheath was exchanged, and the cutting balloon was advanced into the
    area of stenosis within the previously placed stents. This was then
    blown up to appropriate pressures in the 2 areas of stenoses within
    the stents. A followup angiogram showed an excellent result, and it
    was felt that nothing further needed to be done. The sheath was
    then pulled back. An angiogram showed that the sheath was entering
    just at the takeoff of the profunda femoris artery. For this
    reason, a Mynx hemostatic device was used for hemostasis in the left
    femoral artery. Hemostasis was quite good after deploying the Mynx
    device. The wound was covered with a sterile dressing, and the
    patient was taken to the recovery room in satisfactory condition
    having tolerated the procedure well.

  4. #4
    Looking at this note, I would definitely do the 36247-51, but I don't think that I would do the 36248. The cath. was passed down through the SFA and into the Popliteal which would be your 3rd order selection. The Popliteal would be the final catheter destination. I added the 51 onto the 36247 since you also have the 35474 with a higher RVU value.

  5. #5
    You don't think that I need 59's on any of 75774's?

  6. Default
    36247-51(36247 and 35474 are multiple procedure we have to give 51 with the lower RVU)
    75710-59(75710 is a component of 75962 so we have to give 59 mod)

    Hi i think these are the codes for the report, i dont no if 75774 will come thrice
    Last edited by Shirleybala; 11-18-2008 at 03:52 AM.

  7. #7
    My first impression on the codes when I looked at the report were this:

    I was thinking of one 75774 for the final popliteal catheter placement. It was an additional vessel after the main study (aortogram/run-off)

  8. #8
    I choose 36247, 36248. Because the surgeon started in the left femoral, and advanced past the bifurcation and into the right side, and then into the external iliac. He then advanced into the SFA and Popliteal. I don't see how this is all covered in 36247?

    I agree with 75625. 75710. There were also seperate angiograms done in the SFA, and Popliteal.Would this not be coded with additional 75774 X2?

    I thought that I understood caths/angio's. I obviously have no idea what I am doing.

  9. #9
    since the popliteal is an extension off of the SFA, I would only code to highest "stopping" point which would be the popliteal (36247) The angiograms in the arteries along the way would be included in the 75710 (lower extremity run-off). At least that would be my understanding.

  10. #10
    Okay, Thanks MLS2

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