Coding, Classification and Reimbursement

Anatomical modifier on CPT 63044, 63042

  • 1.  Anatomical modifier on CPT 63044, 63042

    Posted 11-20-2018 11:00
    Good morning,

    We received a denial from a payer stating that anatomical modifiers are required for CPT 63044 and 63042. How can we determine which modifer when thos was a back procedure?? Any feedback will be appreciated.
    I'm at a lost.
    Thank you



  • 2.  RE: Anatomical modifier on CPT 63044, 63042

    Posted 11-21-2018 09:29
    Surprisingly, I find that modifier 50, RT, and LT are applicable modifiers for 63044 and 63042.  Those are the only modifiers that are remotely associated as "anatomical" that can be assigned to these 2 codes.
    63044 and 63042 are reportable together without hitting NCCI edits - but I would double check to see if there were any other codes on the claim that might be hitting up against 63044/63042.  Perhaps the payer is (wrong) referring to a separate procedure (i.e. 59, XS) situation.


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    Sheila Goethel
    Coding Services Senior Manager
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  • 3.  RE: Anatomical modifier on CPT 63044, 63042

    Posted 11-21-2018 10:37
    Thank you!! Yes, it's very strange to me.

    We did not get a bundling denial just the anatomical modifer missing denial.

    Not even the providers can tell us if it is LT/RT or if they should consider this as bilateral.