59 Modifier

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READER QUESTION:

It was indicated that Cpt 62323 cannot be billed with 64483 as they are mutually exclusive. Per Cci edits this has a 1 indicator. Doesn’t this mean you can add a 59 modifier?

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There is a reason why it may not bypass the edits because of being mutually exclusive. It is unusual that you can report it together. But yes, you can append a Modifier to indicate the other procedure.

The NCCI Manual provides the following examples of scenarios where two services “cannot reasonably be done at the same session”:

The repair of an organ by two different methods. One repair method must be reported for the repair.
An initial service and a subsequent service. It is considered contradictory for a service to be classified as both an initial and a subsequent service at the same time (with the exception of drug administration services).

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