General Surgery Coding Alert

Question: I reported 10021-59 x 2 for two separate aspirations on the same breast. Medicare denied the second line as a duplicate and paid for one unit only. How should I have coded this?

Arkansas Subscriber

 Answer: Although you are correct to append modifier -59 (Distinct procedural service) to describe two distinct fine needle aspirations (10021, Fine needle aspiration; without imaging guidance), you did not apply the modifier correctly when submitting your claim form.
 
Most payers want you to report the first unit on a separate line with no modifiers attached. You may report second and subsequent units on a second line with modifier -59 appended. In the case described above, therefore, the claim form should read:
 10021
 10021-59.

If the physician performs three or more aspirations, you may use the units box on the second-line item to indicate multiple aspirations, each at a distinct location. For example, for four aspirations, the claim form would read:
 10021
 10021-59 x 3.

Your documentation should indicate clearly that each aspiration occurred at a distinct anatomic location (if even on the same breast) or the payer will likely disallow the second and subsequent aspirations as a duplication of services.