I have some additional comments to make about this discussion.
The question of using mod 59 with add-on codes revolved around a Medicare patient.
Medicare's rationale for the use of mod 59 states that the "Multiple services on one day by the same provider may appear to be incorrectly coded, when in fact the services have been performed as reported. Because the circumstances cannot be easily identified, a modifier was established to permit claims of such a nature [B]to bypass correct coding edits."
I think the general agreement is that, in this instance, there were no edits to bypass. So CCI edits not only tell us when a modifier might be used, they also tell us when they are not necessary.
Regarding the use of LT/RT for other than anatomical specificity, the Medicare Physician's Fee Schedule database indicates that LT/RT can be submitted with 64483, 64484 for reimbursement for bilateral procedures.
Our FI attached this information to a communication received years ago regarding how these modifiers should be used for reimbursement for bilateral and unilateral procedures. For unilateral procedures modifiers LT or RT were to be used.
So, for our Medicare patients for the procedures being discussed, 59 would not be the appropriate modifier to attach to these codes. As I indicated previously, we do have instances when one of these add-on codes is denied. In those cases, we have been instructed to appeal the denial, not add mod 59. The MLN article I referred to stresses the need to avoid using mod 59 if another established modifier is appropriate. Our FI established the appropriate modifier.
I think it was reasonable and prudent to ask why this claim was denied and suggest that the coder contact their FI or Medicare. The reason for denial was never revealed or discussed. Our FI will not tell us what modifier to use, but they will often tell us if one is necessary and where to find the info on their website.
Regarding mod 59 and other carriers, we have used RT or LT for the procedures in question and are paid appropriately. In those instances where a claim has been billed correctly for these procedures and a denial occurs for an add-on code, if the reason for denial is unclear we contact the carrier to resolve the issue.
On a personal note, I think we all are hoping to provide useful information and insights and I think most of us come away feeling educated, but this is, after all, a blog and not a classroom. In that regard phrases like "I hope this clarifies this for everyone" might be avoided. It seems to imply that a definitive answer has been given and may have the effect of shutting down further discussion. What might be useful information for one coder in one part of the country may not be for another. In addition, as a professional courtesy, if a coder has serious concerns about another coder's input, I'd like to suggest that they contact the coder through the Private Message board to discuss the issue rather than immediately adding Disapproving Comments to the coder's profile. I think it would be more in keeping with spirit and objectives of this forum.
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join