CPT® Assistant March 2012 gives tons of examples on proper usage of modifier 25 and modifier 59 including with debridement, arthrocentesis, knee pain at a preventive medicine service, and more. Test your skills with this example (“Debridement Guidelines Update”, CPT® Assistant, March 2012, p. 5):
“A patient undergoes debridement of a subcutaneous wound on the left arm measuring 10 sq cm, a subcutaneous wound on the right arm measuring 20 sq cm, and a 10 sq cm wound, including the bone on the left foot.”
“Although located at different anatomic sites, the wounds on the left and right arm are both subcutaneous at the same level, and their surface areas would be summed (totaling 30 sq cm) and reported as one service,” according to CPT® Assistant March 2012. Report 11042 for the first 20 sq cm and 11045+ for the remaining 10 sq cm. Because the wound on the left foot was at a different level and at a different site, separately report the debridement with 11044. Append modifier 59 to 11042, according to CCI 18.1.
- Free updates on CPT, ICD-9, HCPCS, Medicare, NCCI edits, and ICD-10.
- Discounts on 3rd party offers