Forum - Questions & Answers

Jan 29th, 2015 - Loni10 2 

Coding a 11301, 11301 and a 11301


In a dermatologist's office, if I am coding three procedures using the 11301 three times, should I add the 59 modifier or the 76 modifier to show I am repeating the procedure?

Thee is a debate in the office as to how and why we use 76 over 59, Any help clarifying this would be appreciated!

Jan 29th, 2015 -

re: Coding a 11301, 11301 and a 11301

Modifier 59- is used to identify procedure/services, other than E&M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different sesson, different procedure or surgery, differrent site or organ system, separate incision/exision, separate lesion or spearate injury not ordinally encountered or performed on the same day by the same individual. in other words you would only use this modifier when your are doing different procedures, not the same procedure.

Modifier 76, this modifier is used to indicate that a procedure or service was repeated by the same physicianor other qualfied health care professional susequent to the orignal procdure or service.

the definition of the modifiers are found in the back of the CPT® book as to how to correctly use them. if you have the CPT® 2014 book it is found on page 460. :)

Jan 30th, 2015 - LBAROGIANIS 250 

re: Coding a 11301, 11301 and a 11301

I would only use modifer 76 if we did the same procedure over again another day in the post op period. Example: Recurrent herniated disk.

11301 you're allowed 6 units at one time

so bill 11301 x3

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