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Orthopedic Coding Alert

Reader Questions:

Avoid -59 and -51 With Unlisted

Question: One of our surgeons performed a meniscus transplant (code 0014T) and an open knee arthrotomy (27599). Should I append modifier -59 or modifier -51 to this code pair?

New Jersey Subscriber Answer: CPT deleted 0014T for 2005, so if your claim is for a date of service after Jan. 1, 2005, you should report 29868 instead.
 
If your claim is for a date of service prior to Jan. 1, you don't need either modifier with 0014T (Meniscal transplantation, medial or lateral, knee [any method]), because the surgeon most likely performed the meniscal transplant as an open procedure, not arthroscopically. The arthrotomy would simply be the approach, and it would not warrant an additional code
 
Because your claim requires only one code, modifiers -59 (Distinct procedural service) and -51 (Multiple procedures) are irrelevant in this scenario. However, these modifiers do not apply to unlisted-procedure codes like 27599 (Unlisted procedure, femur or knee) anyway. 
 
According to the August 2002 CPT Assistant, "It is not appropriate to append any modifier to an unlisted code because modifiers provide the means by which the reporting physician can indicate that a service or procedure has been altered by some specific circumstance, but not changed in its definition or code."
 
Unlisted-procedure codes do not describe a specific service; therefore, it is not necessary to use modifiers.


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