Health Information Management

Q&A: Is -59 the only modifier for post-reduction x-rays?

APCs Insider, November 1, 2013

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 Q: In the October 11 APCs Insider, you noted that modifier -59 (distinct procedural service) would be appended to the post-reduction x-ray to indicate it being separate and distinct from the diagnostic x-ray. Is that the only modifier that can be used?

A: No, that is not the only modifier that can be used, and modifier -59 should be the “last resort” for resolving edits.

In the example from the original question, if the HCPCS code for both the pre- and post-reduction study was reported, then modifier -76 (repeat procedure or service by same physician) or -77 (repeat procedure or service by another physician) would be more appropriate for resolving the edit. Modifier -76 and modifier -77 should be used if the same procedure is repeated on the same date of service. If the two procedures performed, documented, and reported involve two different HCPCS codes—e.g., three views of the right wrist pre-reduction (73110) and two views of the right wrist post-reduction (73100)—then modifier -59 may be more appropriate. Any anatomical modifiers (-RT, -LT) would also be reported, if applicable.

The CMS Claims Processing Manual (Pub 100-04), chapter 4, section 20.6.5 – Modifiers for Repeat Procedures – notes:

Two repeat procedure modifiers are applicable for hospital use:

  • Modifier -76 is used to indicate that the same physician repeated a procedure or service in a separate operative session on the same day.
  • Modifier -77 is used to indicate that another physician repeated a procedure or service in a separate operative session on the same day

If there is a question regarding who the ordering physician was and whether or not the same physician ordered the second procedure, the code selected is based on whether or not the physician performing the procedure is the same.

The procedure must be the same procedure. It is listed once and then listed again with the appropriate modifier.

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, Fl., answered this question.



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