Primary Care Coding Alert

Question: When a provider performs an incision and drainage (I&D) on a right breast and another on the right side of the abdomen, should I append the RT (Right side) modifier to both procedures?

Texas Subscriber

Answer: According to the Medicare Claims Processing Manual, “modifiers -LT or -RT apply to codes, which identify procedures, which can be performed on paired organs, e.g., ears, eyes, nostrils, kidneys, lungs, and ovaries. Modifiers -LT and -RT should be used whenever a procedure is performed on only one side” (Source:  www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c04.pdf).

Based on this, you would use the RT modifier on the I&D procedure your provider performed on the patient’s breast, as breasts are paired organs. However, as the abdomen is not a paired organ, appending an anatomic modifier to the procedure is not necessary. You may need to append a different modifier, such as modifier 59 (Distinct procedural service), to the I&D procedure done on the abdomen to indicate it was a separate and distinct procedure from that done on the breast, however, especially if the same CPT^® code is being used to report both I&D procedures.