Results 1 to 4 of 4

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
    Columbia, MO
    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
    Charlotte, NC
    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
    Thank you for the help!!!

Similar Threads

  1. Upper vs. Lower abdomen
    By TammyW in forum Anesthesia
    Replies: 2
    Last Post: 12-24-2012, 07:01 AM
  2. upper vs lower abdomen
    By lovetocode in forum Gastroenterology
    Replies: 4
    Last Post: 09-29-2011, 04:46 PM
  3. Upper and Lower ext doppler
    By hudsondna in forum Cardiovascular Thoracic
    Replies: 1
    Last Post: 11-08-2007, 09:44 PM
  4. Upper and Lower ext doppler
    By hudsondna in forum Cardiology
    Replies: 0
    Last Post: 10-16-2007, 02:00 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.