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The use of Modifier 59

  1. Question The use of Modifier 59
    Medical Coding Books
    If a patient had 3 holes/tears in the right eye, and two of them were superior and lasered (67145) first on 1 DOS, then patient returned 3 weeks later for the same eye had another hole/tear that was inferior can I use a modifier 59 & 79 for the 2nd visit with the same cpt code 67145, since it was another session for a different location in the same eye? I'm so confused!

  2. #2
    Its not "another session". It was a "planned return" right? If so, you would need to use the modifier for planned return to the OR by same surgeon. Modifier 59 wouldn't be applicable because this is the same anatomical site.
    [COLOR="Blue"]Kandy Morris CCS, CCS-P, CPC, CPB, CPC-I, CPMA, CEMC, CPOC
    AHIMA-approved ICD-10CM/PCS Trainer & Ambassador
    AAPC PMCC Approved Instructor

  3. Default
    The code description for 67145 is for 1 or more sessions, so since it was a different location in the same eye at a different encounter I thought modifier 59 would work?
    Last edited by tmr1965; 10-16-2014 at 05:12 AM.

  4. #4
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    Code Description

    Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, 1 or more sessions; photocoagulation (laser or xenon arc)

    Lay Description

    Using a laser light or xenon arc that goes through a dilated pupil without an incision, the physician burns spots at the site of the retinal weakness to seal the retina into place against the choroid (vascular, middle layer of the eye's shell). No incision is made. Multiple sessions may be required.

    Coding Tips

    Multiple sessions are reported only once during the global period. This procedure is generally performed with a topical anesthetic rather than general anesthesia. Surgical trays, A4550, are not separately reimbursed by Medicare; however, other third-party payers may cover them. Check with the specific payer to determine coverage.
    [COLOR="Blue"]Kandy Morris CCS, CCS-P, CPC, CPB, CPC-I, CPMA, CEMC, CPOC
    AHIMA-approved ICD-10CM/PCS Trainer & Ambassador
    AAPC PMCC Approved Instructor

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