Can I combine modifiers 59 and 79 for cpt 50398? Here's the situation--cpt 50393-79, 50394-79, 50398-79, 74480-26, 74425-26, 75984-26; However Medicaid denied 50398 as incidental to cpt 50393. So can i use modifier 59 and 79 or delete 79 and add 59 instead? Thanks in advance--greatly appreciate it! 
History: This is 36-year-old male status post successful PCN now with reentry nephroureteral stent for down sizing to nephrostomy with internal double-J stent placement.
Procedure: The patient was brought to the indices in place on the NG tube prone position. Right flank in excluding 24 French reentry nephroureteral stent was prepped and draped in the usual sterile fashion. 1% lidocaine was used as local anesthetic. Percent and frontal were given for sedation.
Under fluoroscopic guidance existing reentry catheter was exchanged for an Amplatz wire which was advanced into the ileal conduit. Over the Amplatz wire 8 French 26 cm long double-J stent was placed and formed in the renal pelves and ileal conduit. Covering 8F nephrostomy was placed over the wire. Satisfactory position of the double-J stent and nephrostomy was confirmed with contrast injection. Nephrostomy was secured to skin was a suture appears to dressing was applied. Nephrostomy was connected to the Beckford drainage to gravity. There were no complications.
Impression: Uneventful down sizing of the right 24 French reentry nephroureteral stent two 8 French 26 cm long double-J stent with 8 French covering nephrostomy.
History: This is 36-year-old male status post successful PCN now with reentry nephroureteral stent for down sizing to nephrostomy with internal double-J stent placement.
Procedure: The patient was brought to the indices in place on the NG tube prone position. Right flank in excluding 24 French reentry nephroureteral stent was prepped and draped in the usual sterile fashion. 1% lidocaine was used as local anesthetic. Percent and frontal were given for sedation.
Under fluoroscopic guidance existing reentry catheter was exchanged for an Amplatz wire which was advanced into the ileal conduit. Over the Amplatz wire 8 French 26 cm long double-J stent was placed and formed in the renal pelves and ileal conduit. Covering 8F nephrostomy was placed over the wire. Satisfactory position of the double-J stent and nephrostomy was confirmed with contrast injection. Nephrostomy was secured to skin was a suture appears to dressing was applied. Nephrostomy was connected to the Beckford drainage to gravity. There were no complications.
Impression: Uneventful down sizing of the right 24 French reentry nephroureteral stent two 8 French 26 cm long double-J stent with 8 French covering nephrostomy.