Author Topic: Need unbundling code for 90837 with add on 99354 to un-bundle with 96101  (Read 230 times)

barb2512

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Clinical psychologist sees 86 year old for pre-op eval for pain pump. Spends an inordinate amount of time with patient getting history, explaining why the client is there and then administering tests. We billed 90837 with add on code of 99354 and testing 96101 for 2 units. I need to add a modifier to the 96101 to unbundle it from the 90837. Can anyone tell me what the modifier would be?
Thank you
Barbara
Carter

Michele

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I need to add a modifier to the 96101 to unbundle it from the 90837. Can anyone tell me what the modifier would be?
Thank you
Barbara
Carter

I'm assuming you are saying this because the patient's chart indicates that the two services were separate.  I say this because obviously I don't have access to the chart and I'm adamant about making sure people know that you should never as a biller add a modifier to simply get a code paid. 

Now that I've covered that.....I believe it is the 59 modifier that you would use for what you are describing.

"Distinct Procedural Service: 
Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-
E/M services performed on the same day. Modifier 59 is used to identify procedures/services
, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.  Documentation must support
a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual.  However, when another already established modifier is
appropriate, it should be used rather than modifier 59.  Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. 
Note:  Modifier 59 should not be appended to an E/M service.  To report a separate and distinct E/M service with a non-
E/M service performed on the same date, see modifier 25.

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barb2512

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Thank you. I will use modifier 59.  :) :)