Results 1 to 4 of 4

Modifer 59 in Urology ?

  1. #1
    Question Modifer 59 in Urology ?
    Medical Coding Books
    I have a Urologist asking if he can bill the same procedure twice with modifer -59 when he removes more than one calculus during the same session. I am thinking no but I want to be sure.

  2. Default
    It would be best if you would be specific about exactly what procedure he is performing and the anatomic locations of the stones, but the answer will almost certainly be that he cannot do this. The definition of modifier 59 through the AUA's coding website states:

    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.

    This would prohibit him from using 59 in cases when he is doung a u-scope to basket/laser two stones, or when removing more than one stone from the bladder.

  3. #3
    Location
    Austin, Texas
    Posts
    467
    Default
    Look at modifier 22 if extra time is required beyond the usual time for this procedure.
    Marcus Murphy, CPPM

  4. Exclamation is 22 appropriate?
    I would caution against using the 22 modifier for a couple reasons. The first is that it will automatically trigger a manual review, and you will need to send medical records with your 2nd claim when requested. This additional work can take time, and delay payment of your claim for a relatively small procedure.

    Also, by definition modifier 22 states "When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required)."
    I would not say that simply removing another calculus is substantially extra work, makes the procedure more difficult or greatly increases time, technical difficulty of physical and mental effort.

Similar Threads

  1. Modifer 57
    By LStana in forum Modifiers
    Replies: 2
    Last Post: 05-08-2013, 02:21 PM
  2. Modifer 78
    By aracr61 in forum Modifiers
    Replies: 6
    Last Post: 01-10-2012, 04:05 PM
  3. urology coding help, new to urology
    By kerileigh in forum Urology
    Replies: 2
    Last Post: 06-09-2011, 11:37 AM
  4. Modifer?
    By Annacate in forum Family Practice
    Replies: 2
    Last Post: 06-03-2010, 04:20 PM
  5. Modifer 51 - I am new to Radiology
    By LINDA BARBOA in forum Modifiers
    Replies: 2
    Last Post: 06-24-2009, 11:57 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.