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Question about 59 modifier w/uro-gyn surgery

  1. Default Question about 59 modifier w/uro-gyn surgery
    Medical Coding Books

    My surgeon performed a ligament fixation for prolapse (57282) at the same time as a non-OB perineoplasty (56810). We have received a letter from BCBS stating that because these are designated "separate procedures" that we need to bill a -59 modifier on the perineoplasty for it to be paid. However, there are no CCI edits for this combination of codes. I don't want to just put the modifier on without questioning, since this modifier can be a red flag.

    Can anyone shed some light on why BCBS might want this modifier? Is this an appropriate modifier in this case?

    Thank you in advance!

    Agatha O.

  2. #2
    Default Mod 59
    In the Surgery guidelines section of CPT, under Separate Procedure it states :

    "However, when a procedure or service that is designated as a "separate procedure" is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/services by appending modifier 59 to the specific "separate procedure" code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries)."
    Peggy Y, Green, CPC, CPMA, CPC-I, CRC
    "To love what you do and feel that it matters - how could anything be more fun?" Katharine Graham

  3. Default Lab Blood cultures
    If a phys orders blood cultures 4 times do we append modifier "59" to the last three codes?

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