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Eswl-A patient is under

  1. #1
    Default Eswl-A patient is under
    Exam Training Packages
    A patient is under a global period for a Right ESWL. Now she presents for a Left ESWL...which modifier would be the correct one? At the time of the right ESWL, the doctor knew the patient would have to come back to take care of the left ESWL.

    Zaida, CPC

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default 76
    Modifier 76 .... if you are using the exact same CPT code, this indicates a repeat procedure within the global period.

    F Tessa Bartels, CPC, CPC-E/M

  3. #3
    Default Eswl
    Quote Originally Posted by FTessaBartels View Post
    Modifier 76 .... if you are using the exact same CPT code, this indicates a repeat procedure within the global period.

    F Tessa Bartels, CPC, CPC-E/M
    But would it be a repeat if it's on the other side? I thought repeats meant that you would be doing exact surgery, exact site? Just asking, cause I'm confused. I was thinking a 58 modifier? If he knew before he went into surgery that he would have to bring her back for the other side?

  4. #4
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    exact procedure code is appropriate.

    You would not want use the 58 for this scenario. The 58 would only be used if it was a staged/related procedure to the exact site of the primary surgery.

    The 76 will bipass the edits as a duplicate and the rt/lt will show the appropriate site. The carrier "should" be able to tell its a repeat procedure and on the other side

  5. Default
    Hello,
    modifier 59 is mandatory in this case to avoid any confusion.

  6. #6
    Default eswl
    Quote Originally Posted by mbort View Post
    exact procedure code is appropriate.

    You would not want use the 58 for this scenario. The 58 would only be used if it was a staged/related procedure to the exact site of the primary surgery.

    The 76 will bipass the edits as a duplicate and the rt/lt will show the appropriate site. The carrier "should" be able to tell its a repeat procedure and on the other side
    Okay, Thanks for explaining, that makes sense now.

  7. #7
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Quote Originally Posted by lavanyamohan View Post
    Hello,
    modifier 59 is mandatory in this case to avoid any confusion.
    Why do you feel a 59 modifier is "mandatory"?

    There are no other procedures being billed for this DOS therefore I do not feel it is an appropriate modifier for this scenario.

    If both the right and left were being performed on the same day, then it would be justified if you were seperating your line items, otherwise the 50 modifier would be used.

  8. Default
    the stone is not in the same side you should use 79 because it is not a stone related to the first ESWL

  9. #9
    Location
    Kansas City, MO
    Posts
    37
    Default
    79 is the correct modifier. 76 is repeat procedure on the same day. This procedure is not related to the previous eswl (different stone, different side)

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