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Moderate Conscious Sedation and modifiers?

  1. Default Moderate Conscious Sedation and modifiers?
    Medical Coding Books
    If a physician that is performing the procedures for a patient also provides MCS for trigger finger release and excision of a mass on a finger, would you add a modifier to the MCS code?

    26055-F8, 26160-F8-59, 26160-F8-59, 99144-?

    Thanks

  2. #2
    Default
    "Code 26055 is a component of Column 1 code 26160 but a modifier is allowed in order to differentiate between the services provided."

    Per NCCI it would be difficult to report both of these procedures on the same finger.

    I have not seen modifiers that applicable to moderate sedation codes.

  3. Default
    Quote Originally Posted by dwaldman View Post
    "Code 26055 is a component of Column 1 code 26160 but a modifier is allowed in order to differentiate between the services provided."

    Per NCCI it would be difficult to report both of these procedures on the same finger.

    I have not seen modifiers that applicable to moderate sedation codes.
    So in a case where a trigger finger release (26055) where the incision is closed and the 2 masses on that same finger one at the DIP joint dorsoradial surface is excised and closed, then the 2nd mass at the radial border of the fingernail is excised and closed the use of modifier 59 is correct?

    Thanks

  4. #4
    Default
    It looks like the modifier 59 would be required on the 26055 as 26055 is the column two in the code pair.

    I noticed the code descriptor for 26160 states "tendon sheath or joint capsule"

    I assume the edit means if you are excising a lesion of the tendon sheath that they will not also consider payment for tendon sheath incision (eg for trigger finger)

    But your description of the case you are billing sounds more like there was excision of mass involving the joint. This could be interpreted as not treatment of lesions of continous structure if the physician is separately releasing the tendon sheath and excising masses near joint capsule

    The global service data for orthopedic surgery book I have is from 2009 and I don't have the Code X program, so I was unable to look there to see their stance.

    When I look at the NCCI 59 modifier article

    https://www.cms.gov/NationalCorrectC...modifier59.pdf

    I saw the following

    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 softtissue constitutes a single anatomic site. Treatment of posterior segment structures in the eye constitute a single anatomic site

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