Health Information Management

Q&A: What modifier do we use for bilateral diagnostic interventional procedures?

APCs Insider, March 8, 2013

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Q: Our physicians perform diagnostic interventional procedures in the head and neck, represented in the past by CPT® codes 36215-36217. Previously, the cath lab personnel assigned the appropriate 70000 series code to reflect the appropriate supervision and interpretation. With the new 2013 bundled codes, our HIM department is responsible for the assignment of the procedure codes. They are confused about which modifier they should append to the codes defined as unilateral. For procedures performed on the lower extremities, we were instructed to use modifier -59 (distinct procedural service) when the same procedure is performed bilaterally. Which modifier is appropriate?

A: Previously, facilities reported a catheter placement procedure (CPT codes 36215-36218) was reported with the appropriate 70000 series code for supervision and interpretation, when a diagnostic procedure of the head and neck was performed.
 However, effective January 1, the AMA bundled the catheter placement and supervision and interpretation components into one CPT code. CPT codes 36221-36228 now represent the total procedure performed.
With the exception of CPT 36221, these new codes are defined as unilateral procedures. The 2013 CPT coding guidelines state that when the same procedure is performed on both sides, append modifier -50 (bilateral procedure) to codes 36222-36228.
However, if the providers performed a procedure on both sides, but the procedures are not identical, then you should use modifier -59. If the procedures are not identical, it is not a “true” bilateral study, but rather a study of different arteries on different sides of the body. 
CPT codes 36221-36228 did not replace CPT codes 36215-36218 (selective catheter placement above the diaphragm). Coders should still report these codes for catheter placement when the procedure performed requires separate reporting of the catheter placement plus a surgical procedure code, plus a supervision and interpretation code; for example, a therapeutic procedure.
Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

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