Oncology & Hematology Coding Alert

Question: We completed a complex teletherapy isodose plan and basic dosimetry calculation twice on the same day for two separate sites. Should we report modifier 59 or modifier 76 on the second set of charges, or both?

Illinois Subscriber

Answer: Because your staff completed both sets of procedures on the same day, modifier 59 (Distinct procedural service) is a better option than modifier 76 (Repeat procedure by same physician).

Here's why: CPT's Appendix A notes that you report modifier 59 when "a procedure or service was distinct or independent from other non-E/M services performed on the same day."

Documentation care: When you submit the claim, add modifier 59 to the second set of procedure codes. Include a note in the memo field of both plans and calculations explaining the procedure, which field it is for, and why the repeat procedures were necessary.