Correct Use of Modifier 59 with Cytopathology Codes

Often it is not clear whether modifier 59 or modifier 76 should be used with repeat procedures. The Correct Coding Initiative (CCI) Manual provides guidance for the correct usage of modifier 59 with cytopathology CPT codes:

When cytopathology codes are reported, the appropriate CPT code to bill is that which describes, to the highest level of specificity, what services were rendered. Accordingly, for a given specimen, only one code from a group of related codes describing a group of services that could be performed on a specimen with the same end result (e.g., 88104-88112, 88142-88143, 88150-88154, 88164-88167, etc.) is to be reported. If multiple services (i.e., separate specimens from different anatomic sites) are reported, modifier -59 should be used to indicate that different levels of service were provided for different specimens from different anatomic sites. This should be reflected in the cytopathologic reports.

Page Last Updated: Friday, 06-Nov-2009 14:06:54 CST