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Mod - 50: please help settle a disagreement

  1. #1
    Location
    Ellenville, New York
    Posts
    1,176
    Default Mod - 50: please help settle a disagreement
    Medical Coding Books
    A physician has been sending superbills for thyroid biopsies with modifier -50 because he has taken samples from both the left and right side. I say that this cannot have modifier -50 because the thyroid is not a paired organ - there is only one thyroid gland. Who, if either of us, is correct?

  2. #2
    Default
    What is the CPT code? I can use the RBRVS to see if a bilat modifier is allowed.
    Walker Bachman, CPC, CPPM

  3. #3
    Location
    Ellenville, New York
    Posts
    1,176
    Default CPT code
    60100 - did this on both sides. Thank you.

  4. #4
    Location
    Indianapolis, IN
    Posts
    97
    Default
    You are correct. The body does not have a right and left thyroid gland, so you should not use the -50. It would be x2.

  5. #5
    Default
    According to the RBRVS, 60100 is not eligible for mod-50.
    Walker Bachman, CPC, CPPM

  6. #6
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    I would code 60100 and 60100-59 since the biopsies are from different sites of the thyroid gland.
    Lisa Bledsoe, CPC, CPMA

  7. Smile Modifier 51 instead of 59 in this instance.
    I believe modifier -51 is better that -59 in this instance since the procedure is done on the 'same session , same provider' and same approach. Modifier -59 is for a distinct service, 'independent from other services performed on the same day'. For this I looked up the Appendix A in the CPT book.
    I hope this is helpful to you.

  8. #8
    Default
    I have to disagree. Modifier 59 is the appropriate modifier to use. You must differentiate between the two different biopsies. If you don't use mod-59, then the two biopsies will get bundled together and you will only get paid for one of them.
    Walker Bachman, CPC, CPPM

  9. #9
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by djr5958@hotmail.com View Post
    I believe modifier -51 is better that -59 in this instance since the procedure is done on the 'same session , same provider' and same approach. Modifier -59 is for a distinct service, 'independent from other services performed on the same day'. For this I looked up the Appendix A in the CPT book.
    I hope this is helpful to you.
    Mod -59 is the appropriate modifier for "separate biopsies".
    Lisa Bledsoe, CPC, CPMA

  10. #10
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    I would report mod -59 as well. These are separate and distinct procedures.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

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