Health Information Management

Tip of the Week: Do not append modifier -59 and -RT or -LT to the same procedure code

APCs Insider, February 22, 2008

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A Program Memo for fiscal intermediaries (FIs) from June 2000 (PM A-00-36) initially indicated that coders should append an anatomic or bilateral modifier rather than modifier -59 where the anatomic or bilateral modifiers are more appropriate. This continues to be the guidance payers use to indicate how coders should report these modifiers.

If circumstances do not permit coders to report an anatomic modifier, then modifier -59 would apply. Consider the anatomic modifiers first, then, if not appropriate, report modifier -59. Caral Edelberg, CPC, CCS-P, CHC, and Susan Garrison, CPC, CHC, CPC-H, CCS-P, CPAR, would not recommend using both modifiers in this case.

(The above tip was excerpted from the February issue of Briefings on APCs).



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