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Thread: scrutinizing modifier 59 criteria

  1. #1
    Join Date
    Apr 2007
    Everett, WA

    Default scrutinizing modifier 59 criteria

    AAPC: Back to School
    ....can someone please help clarify this even more specificially? "From an NCCI perspective, the definition of different anatomic sites includes different organs or different lesions in the same organ. However, it does not include treatment of contiguous structures of the same organ. For example, treatment of the nail, nail bed, and adjacent soft tissue constitutes a single anatomic site. Treatment of posterior segment structures in the eye constitute a single anatomic site."

    So... treatment performed in the supraorbital region and the auriculotemporal region on the same side of the face would NOT be considered a contiguous structure, and therefore use of modifier 59 would be appropriate or would the fact these procedures were all done in the facial region exclude the use of modfier 59? Can someone break this down into even simpler terms? Sometimes the explanations needs explanation!

    Suzanne E. Byrum, CPC

  2. #2

    Default modifier 59

    Hello, I work for an Endoscopy Center and we use modifier 59 when the doctors ablate polyps or snare them, biopsy them etc in the colon BUT in different locations, IE the rectum vs the transverse colon. So its in the same region BUT different locations and we get paid by Medicare as well as all other insurance carriers each time. Im not sure I answered your question but hope I came close.

    Laurie Masonheimer, CPC (just received certification last week!)
    Last edited by lmasonheimer; 04-04-2010 at 05:25 PM.

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default More specifics please

    It depends on what you mean by "treatment."

    If you're talking about excising lesions, each lesion is considered it's own "area" and so each excision after the first one gets a -59 modifier.

    If you're talking about repairing lacerations ... the same class (simple, layered, complex) in the same body area (for example: face,ears,eyelids, nose, lips and/or mucous membranes for 12911-12018) get added together.

    I know, clear as mud...

    F Tessa Bartels, CPC, CEMC

  4. #4

    Default modifer 59 different location

    Hi Laurie
    nice to know that my understanding is CORRECT
    Want to know which Medicare ? and where are you? Until first half of 2009
    we received mayment for 2112 & 2111 or 2113 & 2114 with modifer 59; however suddenly received denial since latter part of 2009. We are in Southern California (medicare is Palmetto GBA). But not only medicare, all of carrier starting dening. Have been trying to find any WRITTEN ARTICLE to
    appeal to these carriers: (I attended AAPC Gastro seminar in 2007 or 2006
    and learnt that w/59 these to be paid)
    Thank you any help

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