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Modifier 59

  1. #1
    Question Modifier 59
    Medical Coding Books
    If I am billing a 45385 and a 45380 would I use the 59 or 51 modifier?

  2. #2
    Albany, New York
    In this scenario, if the lesion being "biopsied" is a different lesion than the one being removed, you would use modifer "59".
    If not, then only 45385 can be coded.
    Karen Maloney, CPC
    Data Quality Specialist

  3. Default
    You can report both these codes using 59 modifier. The appropriate coding reports the highed valued of the procedure first, unmodified, and add -59 modifier to the second service to indicate that it is separately reportable.

    Prem CPC

  4. #4
    Milwaukee WI
    Default Two lesions or one?
    I agree with Karen. If it's two different lesions (1 biopsied, 1 removed) you'd use the 59 modifier. If it's one lesion (biopsy done first, then removal) you code only the removal.

    F Tessa Bartels, CPC, CPC-E/M

  5. Default Just a detailed explanation
    Codes 45380 and 45384 represent different techniques for taking biopsies of lesions and removing tumors or polyps. These procedures requires the use of different devices.When code 45380 is performed to biopsy a lesion in colon, the identified lesion is removed and/or sampled and then submitted for pathological evaluation.When code 45384 (or 45385) are required to remove separate lesion from colon, the physician performs additional work to accomplish the second procedure. In such instances, the physician must remove one device and advance a different device through the colonoscope to accomplish the second procedure. In these instances it is appropriate to report both codes 45380 and 45384 using 59 modifier.

    Hope this helps..
    Dr.Raja CPC
    Coding Auditor

  6. Default
    what about coding lesion removal(45385) with control bleeding(45382)?

  7. #7
    Greeley, Colorado
    I am in total agreement with FTessaBartels and magnolia1. Also, you cannot code to control the bleeding caused by the polypectomy. IF the area of bleeding is separate from where the polyp was excised, that would be different.
    Lisa Bledsoe, CPC, CPMA

  8. #8
    Default EGD & colonoscopy - modifier 59
    What about coding EGD and colonoscopies -- should 59 or 51 be used.

  9. Default
    If CCI asks to bill with modifier i would use 59. Any other suggestions??
    Dr.Raja CPC
    Coding Auditor

  10. Default
    Quote Originally Posted by rcclary View Post
    If I am billing a 45385 and a 45380 would I use the 59 or 51 modifier?
    You can read an article from American Gastroenterolgical Association (AGA) regarding coding for various colonoscopy procedures. I have posted my suggestions from this and i am sure this helps you too..
    Dr.Raja CPC
    Coding Auditor

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