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Thread: mod 59

  1. #1

    Default mod 59

    AAPC: Back to School
    If you are coding 73560 left knee and 73562 right knee do they bundle and is a mod 59 required to unbundle these?

  2. #2


    No need.

  3. #3
    Join Date
    Apr 2007
    Lubbock, TX

    Default You know how to check NCCI edits?

    Quote Originally Posted by coding201 View Post
    If you are coding 73560 left knee and 73562 right knee do they bundle and is a mod 59 required to unbundle these?
    NCCI edits will answer these questions just about every time - Go to the link below:

    1. Click the blue link that says Radiology 70000-79999
    2. On the nest page, you'll see 2 more blue links - 'Column 1/Column 2 Edits' and 'Mutually Exlusive Edits' - you'll have to check both.
    3. Click the first link, and agree to the disclaimer.
    4. When it asks you if you want to Open or Save the file, click Open.
    5. Depending on whether or not you have Excel, you'll either get an Excel document, or a basic text document - open it.
    6. Go down column 1 and find your first code, then check to see if your second code is in column 2, paired with it. If you do find it, go to step 7, but if you don't see it - go to step 8.
    7. Out beside the code pair, there will be a status of either 0, 1, or 9. 0 Means that the code in column 2 is included in column 1, and you can't override the edit with a modifier. A '1' means that in certain circumstances, you can add a modifier to the column 2 code and have them both paid. 9 means that the codes used to bundle, but don't anymore - in that particular order. If there's a '9', see step 8.
    8. If you didn't find your code set, or you found it with a '9', then continue down column 1, repeating steps 1-7, and reverse the codes (search for the code that was in column 2, in column 1).
    9. If you don't find the codes on the column 1/column 2 table, you'll have to check the mutually exclusive table. Close the Column 1/Column 2 file and go back to the page with the user agreement. Hit the 'Back' arrow on your browser.
    10. Click the link for mutually exlusive, and follow the exact same steps.

    If you look at the picture I attached, you'll see what it looks like. 73560 bundles into 73562 under most circumstances, but there are exceptions that would allow you to appropriately bill both codes with a 59 modifier added to 73560. Please refer to the definition of modifier 59 for more info.

    Hope that helps! Class dismissed!
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