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Topic: Review modifier -59 and T modifiers used for podiatry coding

Ambulatory Surgery Reimbursement Update, September 9, 2008

Coding for podiatry can be fairly complicated due to the number of procedures that may be involved in one case, says Lowell Scott Weil Sr., DPM, FACFAS, chair and CEO of Weil Foot & Ankle Institute and Foot & Ankle Surgery Center in Des Plaines, IL.

Sometimes, those multiple procedures are lost in coding because the coders use the wrong modifier. That may mean you are leaving money on the table, so follow the rules for T modifiers and modifier -59.

Coders for podiatry often misuse modifier -59 and T modifiers and this leads to incorrect coding. Any time a physician operates on a toe, the physician uses T modifiers to identify the toe(s) on which he or she operated. Use modifier –TA to refer to the big toe and then identify the subsequent toes using modifiers -T1, -T2, -T3, and -T4, Weil says.

Coders should use these modifiers only when a podiatrist is operating specifically on toes. If he or she operates on anything behind the toes, a coder would simply indicate whether the procedure was performed on the right side or the left side, Weil says.

Coders should also know when to use modifier -59 to convey those instances in which multiple procedures were separate and distinct. Do not use modifier -51, which you would report when a physician performs multiple procedures on the same date of service.In cases in which the an identical code represents multiple procedures, payers could sometimes misread modifier -51 as duplicate codes reported in error instead of separate, distinct procedures, Weil says.

“[Modifier -59] is the one that gets people into the most trouble,” says Michael Warshaw, DPM, CPC, FACFAOM, healthcare consultant and practicing podiatrist in Ravenna, OH. “According to the government, modifier -59 is used inappropriately 40% of the time.”

Editor’s note: This topic is from the September 2008 issue of Ambulatory Surgery Coding and Reimbursement Insider.

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