Billing > Billing
Appropriate/proper 59 modifier usage
MedBiller:
As usual, thanks for any assistance provided...
Need clarification regarding infamous "modifier 59"
I understand that it represents a procedure that is distinct or independent from other services performed on the same date. When appropriate; I have used it in the following scenario: E/M service with modifier 25 and 96372 with modifier 59. If applicable, How would I utilize it properly when billing the following? Can I use it more than one?
99214 w/ mod 25 (office visit level 4)
36415 (vein.)
85025 (CBC)
96365 (initial hour non-chemo infusion)
96366 X 2 (additional hours non chemo infusion)
96367 (Subsequent hours non chemo infusion)
96361 (additional hours hydration)
96372 (B12 injection)
I was taught to place the 59 modifier on the primary procedure code only (96365), but I believe that might be incorrect. Thanks!
Michele:
I am not a certified coder so I am not sure. IMO, the 59 modifier is not needed since you are using the 25 on the E&M. However, I am wondering if you are a coder. If you are not, shouldn't the charges be coming over to you with the modifiers indicated by the provider? Just wondered.
Michele
medauthor:
I am going with Michele here....but take a look at what CMS says https://www.cms.gov/MLNMattersArticles/downloads/SE0715.pdf
oneround:
The ladies have given somne really good points here. i would let your coder handle this and and I say this because mod. 59 is a highly misused modifier and has been abused big time by many. This mod. is highley subceptible to audits and was a main focus point for the OIG at one time. Mod. 59 does not have to be coded on the primary procedure but is placed on the code that is usually bundled into the primary procedure. Again, this is a high profile modifier and as the ladies stated
THER/PROPH/DIAG INJ, SC/IM M 96372 is a component of Column 1 code 96365 but a modifier is allowed in order to differentiate between the services provided (Again when in doubt-send it back to the coder to cehck it out)
medauthor:
--- Quote ---96372 (B12 injection)
--- End quote ---
I just realized....where is your J3420? Is this on your claim, as well?
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