General Surgery Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: When pressure ulcers are debrided at multiple sites, should we use modifier -59 to indicate that different areas were debrided?

South Carolina Subscriber

    Answer: If the sites are on the same side of the body, modifier -59 (Distinct procedural service) should be used to report the second (or multiple) debridements. If the debridements are performed on different sides, however, most Medicare carriers prefer that modifiers -LT (Left side) and -RT (Right side) be used. The second and any subsequent debridements will be reimbursed at a 50 percent rate.
 
Without a modifier, multiple debridements are likely to be denied. Because some carriers do not recognize modifiers, each debridement should be entered separately with the appropriate modifiers assigned and comments entered to describe the location of each area. The comment field (box 19 of the CMS Form 1500), which often can be helpful in obtaining timely payment, should include a short statement next to each procedure indicating the site of each debridement.