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need mod 59?

  1. Default need mod 59?
    Medical Coding Books
    Hi every one,

    I have a question do we need to append 59 mod for any service if it is done on different side or diferent toe/finger.

    Example 28285 -TA and 28285 -59-T1. or any other service .

    TA and T1 or LT and RT not sufficient? TA, T1 and RT/LT tell that service is done on different sites again why 59 mod?

    when we code x-ray of both knees 3 views .

    73562-26rt and 73562-26-lt is this is not sufficient or do we need to have 59 mod to LT again?

    Thanks in advance for all the responses.


    Prem.
    Last edited by prem_ponnuru; 09-11-2008 at 04:14 PM.

  2. #2
    Location
    ENGLEWOOD/DENVER
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    2,338
    Default
    My answer to this is Yes (some will disagree with this methodology).

    If you are using the same CPT code but on two separate/different lines then yes, the 59 modifier is necessary on the 2nd code to identify the separate/different site of surgery. Unfortunately there are many carriers that do not even recognize the T and F modifiers thus the need for the additional modifying.

  3. Default
    I have found most carriers will honor the site specific modifiers(HCPCS Level II). These identify the seperate sites respectively.
    You can just as well use -59 on the second procedure, however in my experience - payors tend to hold payment pending review of the full operative report when using -59. I think this is primarily due to electronic transmissions. Apparantly when they are submitted electronically, only the first modifier on each claim line is transmitted/ read. Even if my second line contains -59 then -LT - the transmission is not including the second modifier, so they're holding the claim for additional info either way. I have inquired with payors as to why this is an issue, but have never received a clear response. - So... I continue to use Bilateral or Site Specific as appropriate. =)
    Good luck!

  4. #4
    Location
    NCF Gainesville
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    64
    Default
    Quote Originally Posted by prem_ponnuru View Post
    Hi every one,

    I have a question do we need to append 59 mod for any service if it is done on different side or diferent toe/finger.

    Example 28285 -TA and 28285 -59-T1. or any other service .

    TA and T1 or LT and RT not sufficient? TA, T1 and RT/LT tell that service is done on different sites again why 59 mod?

    when we code x-ray of both knees 3 views .

    73562-26rt and 73562-26-lt is this is not sufficient or do we need to have 59 mod to LT again?

    Thanks in advance for all the responses.


    Prem.
    You will need the 59 mod if you do a procedure on different sites; however, when billing for radiology, we only use the LT/RT modifiers. Not sure I can give you the details as to why, but I know that this is all that is required for our radiology side of billing.
    Jeni Smith, CPC, CPMA

  5. #5
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    prem_ponnuru,
    yes, using modifier .59 would be the best modifier to use in your scenario. (same CPT code, different sites). As for xrays - there is an xray code for bilateral knees, (73565)....so that might be the better code to use (if that's indeed what is being done) otherwise, it seems for xrays for some reason the RT/LT is liked best, however if it's "bilateral" the .50 modifier would be the more appropriate code to use. Unless of course the code specifically states bilateral/ ("both" such as 73565).
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  6. #6
    Default Mod 59
    I have a modifier decision tree from Part B insider Vol 9 no. 29 that indicates a decision tree like this:

    If the physician performed the second procedure on the same day, was it staged or related to the first procedure?

    If yes: append modifier 58 to the staged/related procedure code.

    If no: Did the physician perform the procedure on separate toes, feet, or sides of the body?

    If no you can append the modifier 59 to the second procedure.

    If yes, use the appropriate site modifiers, such as LT, RT, or toe modifiers (TA, T1 through T9) as appropriate, if your payer accepts them. If your payer does not accept these, use modifier 59.

    The use of modifier 59 is a dilemma for most of us.
    When to use 59, 51, TA, etc. I have always been told: If there is a better, more descriptive modifier, use that.
    Sorry, can't be more clear, from reading everyone else's answers, it's pretty much as I have thought, it's a matter of your decision and what you think is best at that time with that case.

  7. Default Thx for response
    Thx for all the responses.

    So, It is not wrong if I use only RT/LT or other T or F modifiers without 59.

    But it depends upon the client specifications.

    Prem.

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