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modifier 50-debridement performed

  1. #1
    Default modifier 50-debridement performed
    Exam Training Packages
    Good morning coding world.

    Can modifier 50 be used for a debridement performed on RT or LT heel

    Eg:

    11043 707.07 707.25
    11043 50 707.07 707.25

    Thank you for your response

  2. #2
    Location
    Greeley, Colorado
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    Because wounds are not always right vs left, you should use modifier -59 for the separate site.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Location
    Columbia, MO
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    12,570
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    Lisa is correct, these are skin debridments and skin is one organ without laterality so you use a 50 modifier to indicate a separate site of the same organ.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default
    Thank you for your quick response...

    The scenerio I have is

    The doctor see the patient with two pressure ulcers on the buttock. He document one on the Rt side and one on the Lt side. Both ulcers were debrided to Muscle with staging of 4

    11043 707.05 707.24
    11043 59 707.05 707.24 (the second procedure is being denied by mcr as duplicate)

    I'm trying to understand why they would deny with the 59 modifier???

  5. #5
    Location
    Columbia, MO
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    It is probably due to your ICD-9 being the same for both codes, so you will need to appeal this with the documentation. Also after January 1 you will only be able to report his code once for each 20 sq cm.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Location
    Albany, Oregon
    Posts
    53
    Default Debridements
    Agree with above.
    However.... Ingenix reports that modifiers RT and LT are acceptable modifiers for CPT 11043. That might be an option..
    Good luck, pat

  7. #7
    Default
    Thanks everyone,


    There are guidelines for 2011 on how to list pressure ulcer DX.

    if its the same site location but different stages they are to be repeated

    eg:
    11043 707.05 707.23
    707.05 707.24

    In the case that everything is the same you will code 707.05 707.23 once.

    I appreciate the guidelines for pressure but what if its mutiple wounds (non pressure)
    that are debrided to the same depth ???

    for example for this visit there was 5 debridements (open wounds, pressure wound)

    eg:
    11043 707.05 707.23
    707.05 707.23
    877.1 (same location as ulcer its on the buttock)
    440.23
    707.07 707.23

  8. #8
    Default
    Pat,

    Athena is putting our claims on hold when we use rt and lt.

  9. #9
    Location
    Columbia, MO
    Posts
    12,570
    Default
    Quote Originally Posted by coder1 View Post
    Thanks everyone,


    There are guidelines for 2011 on how to list pressure ulcer DX.

    if its the same site location but different stages they are to be repeated

    eg:
    11043 707.05 707.23
    707.05 707.24

    In the case that everything is the same you will code 707.05 707.23 once.

    I appreciate the guidelines for pressure but what if its mutiple wounds (non pressure)
    that are debrided to the same depth ???

    for example for this visit there was 5 debridements (open wounds, pressure wound)

    eg:
    11043 707.05 707.23
    707.05 707.23
    877.1 (same location as ulcer its on the buttock)
    440.23
    707.07 707.23
    Check the guidelines again, if more than one ulcer of the same site but different stages you will have one site code but different stage codes, if you have same site and smae stages then you list each code only once. you do not list the same ICD-9 code more than once, you may link it more than once.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Default
    Thank you so much, I looked the guidelines over your correct. I didn't view it myself and wanted feedback because it didn't make sense to me. Thanks again!!!

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