APMA News - January/February 2021 - 25

reason for the distinct procedural service more specifically. CMS
states, " Modifier 59 should only be used if no other more specific
modifier is appropriate. " It is never appropriate to append
both modifier 59 and an X modifier to the same CPT code.
From the NCCI perspective, the definition of distinct anatomic sites includes different organs or different lesions on
the same organ. However, it does not include treatment of
contiguous structures on the same organ. A typical example
seen in podiatry is the nail, nail bed, and soft tissue adjacent
to the nail, which are all considered to be part of a single
anatomic site.
When selecting a modifier to bypass an NCCI procedure-to-procedure edit, it is the provider's responsibility to determine which is most appropriate. The 59 modifier should
only be used if no other, more specific, modifier is appropriate.

Examples of Use
XS modifier-The right subtalar joint is injected, and CPT
20605 is submitted; the left subtalar joint is also injected at the
same session, also represented by CPT 20605. In this scenario,
modifier XS would be appended to the second injection code.
Typically, an LT or RT modifier is not needed in this scenario.
Modifier 59-A benign skin neoplasm is removed from the
left foot, represented by CPT 11422, and a benign skin neoplasm is removed from the right ankle at the same session,

represented by CPT 11402. In this example, it would be appropriate to append modifier 59 to CPT 11402. In this example, the same procedure was performed on the same organ
system and structure, which is the skin, but there were different lesions anatomically.
Modifier 59-A total nail avulsion and an incision and
drainage of an abscess are performed at separate sites. In this
example, CPT 11730 is paired with CPT 10060 by the NCCI
edits, with CPT 11730 as the column two code of the pair.
The XS and 59 modifiers should not be used when CPT
11730 and 10060 are performed at the same anatomical site.
However, when performing these two procedures at different
anatomical sites, the proper coding is CPT 10060 and CPT
11730 with T(A-9) and 59 modifiers. Using both codes is allowed, and appending modifiers to CPT 11730 is required to
demonstrate that the procedures were performed on the organ system and structure, which is the skin, but these were
different sites anatomically.
View a recent webinar on modifier 59 use and access the
APMA 59 and X[E,S,P,U] tool kit by visiting https://www.
apma.org/News/NewsDetail.cfm?ItemNumber=42335.
Current Procedural Terminology (CPT®) is copyright 1966,
1970, 1973, 1977, 1981, 1983-2020 by the American Medical Association. All rights reserved. CPT is a registered trademark
of the American Medical Association (AMA). n
APMA News January/February 2021

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APMA News - January/February 2021

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