You Be the Expert: CT of the Head

Question: We coded/billed the following:

70470: CT of the head
70482-50: CT of the orbits

We are still getting an edit. What modifier are we missing? Is it -59?

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Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.



Answer: Code 70482 (computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followed by contrast material[s] and further sections) is inherently a bilateral procedure, thus appending a -50 modifier (bilateral procedure) is inappropriate. Code 70482 is a component of 70470 (computerized axial tomography, head or brain; without contrast material, followed by contrast material[s] and further sections) and is mutually exclusive. If you attempt to code for both procedures by appending modifier -59 (distinct procedural service), you will be in a difficult position to clinically justify how the CT of the orbit is a distinct procedure. The radiologist must provide you with substantial documentation to justify billing for both.

- Published on 2001-01-01