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Wiki 70544 and 70457

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hbarney1

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Good morning,

I received a denial for these codes needing a modifier (2017). I did look at the CCI edits and unable to find them on there. The locations are different, but the time is the same. Would I append a mod 59? The CPT book doesn't state any restrictions with these codes.
 
70457 is not a valid code in any of my reference materials going back to 2015 - is that the correct CPT? Also, a modifier can be required for reasons other than CCI edits - it could be due to a number of different reasons or payer-specific requirements. It might be best just to contact the payer and find out exactly what type of modifier they are looking for.
 
For 70547, I agree with you, there are no CCI edits. Although not all payers follow CCI, I would still recommend contacting the payer since it was denied for a missing modifier. Usually if codes are bundled by a payer, the denial will state this and if it does not, then I don't think you will solve this by adding a modifier 59.
 
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