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Thread: upper and lower GI w/ mod 59

  1. #1
    Join Date
    Apr 2007

    Default upper and lower GI w/ mod 59

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007


    Thank you for the help!!!

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