1. Anne Niesen
   Posted 3 months ago #
   

   A patient presents with 2 abscesses in both the right and left groin, a total of four abscesses. We assigned 10061, and 10061 modifier 59. Modifiers RT and LT are not allowed on this code, which would have been a great help in trying to explain the scenario. Modifier 59 was used to alert them it was a different location. I have submitted Redetermination and Reconsideration explaining that there were four total abscesses, two on the right groin and two on the left groin. Medicare denied due to; Medicare only allows this service once per day.
   I don't se anything on the CMS website stating this. Any ideas?

2. SuperCoder
   Posted 3 months ago #
   

   1)
   For this CPT, for modifier 50, the modifier Indicator is "0" which means 150% bilateral payment adjustment doesn't apply. Payment for two sides (50 or RT/LT) is lower of (a) actual charge for both sides or (b) fee schedule amount for single code.
   2)
   CPT 10061 itself is for multiple abscess drainage. So, it's MUE is "1", so you can't use this code more than once on same DOS. Since this code descriptor justifies for multiple units, so you can't use any modifier to bypass MUE edits.

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