Deciding to Use Modifier 59 on Certain Procedures

Sometimes in medical billing it is difficult to decide when to use current procedural terminology codes 58661 and 49322-59. These codes, like many others seem similar, but in actuality, are quite different. When performing medical billing it is necessary to know when to use current procedural terminology code 58661 versus 49322-59.

The medical billing code 58661 (laparoscopy, surgical; with removal of adnexal structures) is used when any part of the ovaries or Fallopian tubes are removed. For example, If a surgeon was doing a cystectomy of an ovarian cyst and ended up removing some of the ovary as well, they physician could do medical billing with 58661.

The current procedural terminology code 49322-59 (laparoscopy, surgical; with aspiration of cavity or cyst) should only be used for the aspiration of an ovarian cyst. If the cyst is removed, this medical billing code would not be valid since it is for aspiration only.

There are several instances in medical billing where it seems as though several codes would fit the description. The truth, is that most of the time there is only one possible current procedural terminology code that would explain a procedure best. It is important that the personnel that perform medical billing for your practice are educated on this slight differences. It could mean the difference between getting reimbursed on a claim or getting denied.

View all Articles by: Kathryn Etienne, CCS-P