# Which modifier would I use?



## jdibble (Nov 26, 2014)

Which modifier would you use and on which code for the following scenario:

Patient had an abdominal aortagram and bilateral fermoral angiogram with run-off and then selective catheter placement in the the left popliteal artery.  This was followed by placement of an EKOS catheter with TPA treatment for 8 hours on the same date of service.  I used codes 36247, 37211, 75625-26-59, 75716-26-59.  

After the 8 hours, on the same date of service, the patient was brought back to the operating room for a post-thrombolytic left femoral angiogram, removal of the EKOS and stenting of the distal left superficial femoral artery.  I am using code 37226.

If these are the correct codes, CCI edits say that code 36247 is bundled into 37226 and I need a modifier applied to bill both (modifier should be applied to 36247 - the first procedure).  Should I code it that way with a 59 modifier on the 36247 even thought the other procedure was second. Or would I use modifier 58? And if so, which code would I apply that to?

Any suggestions?

Thanks,


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## zoting.arvind@gmail.com (Nov 27, 2014)

37226 is lower extremity intervention code which include the selective catheterization cpt codes (36245-36247), hence we cannot code this together, so only 37226 should be reported..


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## zoting.arvind@gmail.com (Nov 27, 2014)

if the access of both procedure is different you can code 36247 with 59 modifier along with 37226......if same access we have to use 37226 only


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## jdibble (Dec 1, 2014)

> 37226 is lower extremity intervention code which include the selective catheterization cpt codes (36245-36247), hence we cannot code this together, so only 37226 should be reported..





> if the access of both procedure is different you can code 36247 with 59 modifier along with 37226......if same access we have to use 37226 only



These were 2 separate sessions - on the same date of service, but 8 hours apart.  The physician performed Thrombolysis using TPA with an EKOS catheter for 8 hours. He then returned the patient to the procedure room for a post-thrombolytic angiogram - 8 hours later, at which time he made the decision to perform the stenting.  So the question is - is this a separate distinct procedure, modifier 59 or a staged procedure, 58 modifier?

Thanks!


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## zoting.arvind@gmail.com (Dec 2, 2014)

need to check the whole report, depends if the patient had any complication after first session or this was a planned visit by the patient...please post the whole report


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