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upper and lower GI w/ mod 59

  1. #1
    Default upper and lower GI w/ mod 59
    Medical Coding Books
    When billing an upper and lower GI, using cpt codes 45378 and 43235, is it appropriate to append a modifier 59 to 43235?

  2. #2
    Location
    Columbia, MO
    Posts
    12,840
    Default
    when the code descriptors already identify the procedures as distinct and separate from one another there is no need or requirement for the 59. So when one procedure indicates a different orifice from the other then there is no reason to use the 59 to indicate distinct and separate.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Charlotte, NC
    Posts
    534
    Default
    Don't need to.

    You may need a 51 modifier to show multiple procedures but many payors have done away with needing them (medicare has specifically stated to not use the 51 as their system does it for them/you).

    The 59 modifier is used to show codes normally done at the same time (45380 and a 45385) are done at the same time but there is a reason you did them and need to be reimbursed for that service, (ie a polyp in the ascending colon is snared and a polyp in the sigmoid colon is cold biopsied).

    You should check the NCCI bundling edits.

  4. #4
    Default
    Thank you for the help!!!

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