# Modifer 59



## cmblocher (Nov 17, 2008)

I am trying to learn when to use modifer 59 on S&I codes. I am struggling.
Here are the codes I have selected: 
36247     (SFA Cath)
36248     (Popliteal Cath)
35474     (PTA SFA)
75630-26 (Aortogram-bilateral illiac run-off)
75774-26 (external iliac)
75774-26 (SFA)
75774-26 (Popliteal)
75962-26 (PTA S&I)

Any help would be very much appreciated.


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## MLS2 (Nov 17, 2008)

would you have a copy of the report that I could see?  I don't see anything that would need a 59 mod. with these codes.  Either a 76 or 59 on the additional 75774's depending on the payer though...


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## cmblocher (Nov 17, 2008)

Could you give me an example of when it would be necessary to use modifer 59? Thanks for looking at this note.

OPERATION:          Right superficial femoral artery percutaneous 
 transluminal angioplasty (PTA) with a cutting balloon.   

ANESTHESIA:    Local with sedation.  

PROCEDURE:     The patient was placed in the supine position on the 
 operating table.  The area was prepared and draped in the 
 appropriate manner.  Local infiltration was carried out. 
 Percutaneous entry into the left femoral artery was accomplished. 
 The guidewire and sheath were inserted.  A retrograde aortogram was 
 done showing a normal distal aorta and iliac runoff.  The catheter 
 was passed over the aortic bifurcation down into the external iliac 
 on the right side, where an angiogram was performed of the right 
 groin.  This showed a patent superficial femoral artery and profunda 
 with 2 visible stents in the proximal superficial femoral artery. 
 The catheter was then passed down through the stents and into the 
 superficial femoral artery just distal to the stents.  Further 
 angiography was done showing some irregularity, but no significant 
 narrowing in the superficial femoral artery.  The catheter was 
 passed down into the popliteal.  Further angiography showed again a 
 narrowing in the popliteal, but this did not appear to be 
 hemodynamically significant.  There was no hold up in dye.  The 
 anterior tibial and peroneal were open down to and into the foot. 
 The posterior tibial was hardly visible and had significant disease 
 within it.  It was only intermittently open down to the ankle.  It 
 was felt that nothing could be done in the posterior tibial.  The 
 sheath was exchanged, and the cutting balloon was advanced into the 
 area of stenosis within the previously placed stents.  This was then 
 blown up to appropriate pressures in the 2 areas of stenoses within 
 the stents.  A followup angiogram showed an excellent result, and it 
 was felt that nothing further needed to be done.  The sheath was 
 then pulled back.  An angiogram showed that the sheath was entering 
 just at the takeoff of the profunda femoris artery.  For this 
 reason, a Mynx hemostatic device was used for hemostasis in the left 
 femoral artery.  Hemostasis was quite good after deploying the Mynx 
 device.  The wound was covered with a sterile dressing, and the 
 patient was taken to the recovery room in satisfactory condition 
 having tolerated the procedure well.


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## MLS2 (Nov 17, 2008)

Looking at this note, I would definitely do the 36247-51, but I don't think that I would do the 36248.  The cath. was passed down through the SFA and into the Popliteal which would be your 3rd order selection.  The Popliteal would be the final catheter destination.  I added the 51 onto the 36247 since you also have the 35474 with a higher RVU value.


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## cmblocher (Nov 17, 2008)

You don't think that I need 59's on any of 75774's?


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## Shirleybala (Nov 18, 2008)

36247-51(36247 and 35474 are multiple procedure we have to give 51 with the lower RVU)
35474
75625
75710-59(75710 is a component of  75962 so we have to give 59 mod)
75962

Hi i think these are the codes for the report, i dont no if 75774 will come thrice


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## MLS2 (Nov 18, 2008)

My first impression on the codes when I looked at the report were this:

75625
75710-59
36247-51
75962
35474
I was thinking of one 75774 for the final popliteal catheter placement.  It was an additional vessel after the main study (aortogram/run-off)


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## cmblocher (Nov 18, 2008)

I choose 36247, 36248. Because the surgeon started in the left femoral, and advanced past the bifurcation and into the right side, and then into the external iliac. He then advanced into the SFA and Popliteal. I don't see how this is all covered in 36247?

I agree with 75625. 75710. There were also seperate angiograms done in the SFA, and Popliteal.Would this not be coded with additional 75774 X2?

I thought that I understood caths/angio's. I obviously have no idea what I am doing.


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## MLS2 (Nov 18, 2008)

since the popliteal is an extension off of the SFA, I would only code to highest "stopping" point which would be the popliteal (36247)  The angiograms in the arteries along the way would be included in the 75710 (lower extremity run-off).  At least that would be my understanding.


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## cmblocher (Nov 18, 2008)

Okay, Thanks MLS2


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