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Modifier 59 position

  1. #1
    Default Modifier 59 position
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    I received a claim back for a 29822 and a 23120. According to RVU's 29822 is Line one followed by 23120.
    29822 is a component of 23120 and a modifier is needed to unbundle. So when I entered my charges this is what it looked like.
    29822 SG59LT
    23120 SGLT

    The 29822 was denied because the insurance didn't like the 59 on the first line. Is it appropriate to either
    1. switch the order of the CPT codes or
    2. Put the 59 modifier on the line that has no bundling issues?

    Thank you,
    Carmel

  2. #2
    Location
    Duluth, Minnesota
    Posts
    1,133
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    I'd switch the order of the codes. I wouldn't put the .59 on the 23120.
    23120.SG.LT
    29822.SG.59.LT

    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  3. #3
    Default
    Are you billing for an ASC...The 'SG' modifier is not valid anymore for an ASC...try removing the SG modifier!!
    NoRaX

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
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    You should always use the modifier that "drives the payment" first. So in this case, -59 would come first. Also, NELENAZ is correct -SG is not required UNLESS you are billing a payor who has not followed the rest of the pack (in my case Rocky Mountain Health Care). Happy Coding!
    Lisa
    Lisa Bledsoe, CPC, CPMA

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