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59 mod

Vera Posted Fri 18th of October, 2013 15:39:51 PM

It is okay to code these three CPT's like this: 99213.25 - dx 707.15
250.62
97597 - dx 707.15
250.62

11721.59 - dx 110.1
250.62

I have heard this is not correct, but to me ..... 11721 is a totally seperate procedure than the debridement of the ulcer.... this is diabetic nail care and seperate, and should be paid seperate??? Right??? Thank you.

SuperCoder Answered Mon 21st of October, 2013 08:59:39 AM

For 11721 to be reported with mod 59 along with 97597, one would need a separately identifiable medical necessity documentation. In this case, the debridement of nail being reported with 11721 is again related to the same pathology for which 97597 is being performed. However, if the site of performance of 97597 and 11721 are documented to be separate and distinct sites, then 11721 with 59 modifier would be reportable and should be payable separately subject to payor preferences.

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