Modifier 59 and 51. Do we need both?

Question:

Should we append both 59 and 51 when a code is bundled and is also a subsequent procedure?

Answer:

Modifier 59 is only used if two codes are bundled, specifically if there is a NCCI edits for the two codes. If there is no edit, a modifier 51 is used.  Over-use of modifier 59 is an audit target, so its use should be reserved for this scenario.

And when modifier 59 is used appropriately, a modifier 51 is redundant and unnecessary. Modifier 59 is always placed on a subsequent, lower valued code negating the need for modifier 51.

*This response is based on the best information available as of 11/01/18.

Trauma Laparotomy

Question:

Is there a specific CPT code for trauma laparotomy?

Answer:

No. if an exploratory laparotomy is performed and no injuries are detected and repaired,Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)is coded. If the retroperitoneum is also explores code 49010Exploration, retroperitoneal area with or without biopsy(s) (separate procedure)instead of 49000. Both codes would never be reported together.

Note that each laparotomy code is designated as a separate procedure, meaning they are bundled if any more complex procedure is perfumed. So if the spleen is removed, the liver repaired, small bowel resections are performed, etc., only those definite procedures would be reported.

*This response is based on the best information available as of 10/18/18.

Coding Mesentery Repair

Question:

Documentation states that the mesentery was repaired as part of where the liver was packed. How is this reported?

Answer:

Code 44850,Suture of mesentery (separate procedure)is designated as a separate procedure and therefore is included in the more comprehensive procedure, the liver packing.  The separate procedure designation means that the procedure is usually a component of a more complex service and is not reported in addition to the more complex service in performed in the same anatomic area.

*This response is based on the best information available as of 10/04/18.

Coding a Colotomy

Question:

How is this scenario coded?  A segment of the colon is opened to remove a foreign body and then closed. No resection and no perforation.

Answer:

The scenario you describe is a colotomy; making an incision in the colon through which the colon is explored for biopsy or foreign body removal This is coded as 44025,Colotomy, for exploration, biopsy(s), or foreign body removal.

*This response is based on the best information available as of 09/06/18, 3:00 PM Central Time (CT).

Thrombolysis Through a Chest Tube

Question:

How is installation of tPA into a chest tube coded?

Answer:

Report this with the following codes:

CPT Code	Description
?32561	Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolytic agent for break up of multiloculated effusion); initial day
?32562	subsequent day

Each of these codes is reported once per day only.

*This response is based on the best information available as of 10/30/18.

Ligating a Vessel in a Trauma Patient

Question:

What codes are used for ligating a vessel due to a traumatic injury?

Answer:

See codes 37565-37618, below. Select a code based on the anatomic area of the vessel. For example, Ligation, major artery (eg, post-traumatic, rupture); neck for ligating the jugular vein.

CPT Code	Description
37565	Ligation, major artery (eg, post-traumatic, rupture); neck
37616	chest
37617	abdomen
37618	extremity

*This response is based on the best information available as of 07/18/18.