# Modifier -59 Usage



## cplummer (Aug 24, 2012)

I have an ongoing debate about the proper usage of modifier -59.  

This is the scenario.  A patient had a chest x-ray (a/p view) in the morning to evaluate the position of a catheter, after trying to pull it out at the right jugular.  That afternoon, the MD did another chest x-ray to evaluate the left jugular to place a catheter in that side, since the right side was too occulded to replace it.  Should modifier -59 distinct procedure or modifier -76 repeat procedure be used.  

Can someone clarify which modifier is more appropriate for me?

Thanks


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## bwolfe1 (Aug 24, 2012)

I would use the -76 in this case.  The -59 is used when procedures are performed at the same time and used to show that one procedure is distinct from the other, not just a multiple procedure; ie abdominal hysterectomy with ovarian cystectomy.


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## berryc (Aug 24, 2012)

Per CCI Guidelines:

When a central venous catheter is inserted, a chest radiologic examination is usually performed to confirm the position of the catheter and absence of pneumothorax. Similarly when an emergency endotracheal intubation procedure (CPT code 31500), chest tube insertion procedure (e.g., CPT codes 32422, 32550, 32551), or insertion of a central flow directed catheter procedure (e.g., Swan Ganz)(CPT code 93503) is performed, a chest radiologic examination is usually performed to confirm the location and proper positioning of the tube or catheter. The chest radiologic examination is integral to the procedures, and a chest radiologic examination (e.g., CPT codes 71010, 71020) should not be reported separately.

When limited comparative radiographic studies are performed (e.g., post-reduction, post-intubation, post-catheter placement, etc.), the CPT code for the radiographic series should be reported with modifier 52 indicating that a reduced level of interpretive service was provided. This requirement does not apply to OPPS services reported by hospitals.


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