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Mod 59 help

  1. #1
    Default Mod 59 help
    Medical Coding Books
    I know that modifier 59 can be used to indicate a separate compartment of the knee (ex: 29881, 29877-59)....but can it also be used on Arthroscopic procedure of the shoulder??

    Ex: 29826, 29824/51, 29822-59 when subacromial decompression, distal clavical resection and debridement of the labrum and rotator cuff is performed??

    CCI says 29822 cannot be used with the other codes...but I was wondering if modifier 59 could get it paid when used with 29826 and/or 29824 since it was performed in different area.

  2. #2
    Albany, New York
    yes, if your documentation supports coding it as a separate procedure.
    Karen Maloney, CPC
    Data Quality Specialist

  3. #3
    Columbia, MO
    One of the things they look for in the documentation is to see that the scope is withdrawn from one compartment and entered into the next, and that the debridement was therapeutic for the patient and not just for the convenience of the physician in order to move the scope around more freely.

  4. #4
    CPT 29822 (Per NCCI) bundles into CPT 29826 with a Modifier Indicator of
    '1'. However, if the procedure meets the criteria in the description of Modifier 59, you may affix Mod 59 and bill.

    Fran Allery CPC

  5. Default
    I bill all those together with 59 on 29822 and I get paid.

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