Gastroenterology Coding Alert

With all the CCI bundling going on,it's time for a refresher on unbundling. Nowadays, whenever the Correct Coding Initiative (CCI) comes up, coders automatically think "modifier 59." But the "unbundler" is often misunderstood -- and misused. According to the Medicare Claims Processing Manual and the CPT Manual, modifier 59 (Distinct procedural service) indicates that a provider performed a distinct procedure or service for a beneficiary on the same day as another procedure or service. It may represent a: • Different session, • Different procedure or surgery, • Different anatomical site or organ system, • Separate incision or excision, • Separate lesion, or • Separate injury (or area of injury in extensive injuries). First and foremost, your documentation must be correct. Modifier 59 popped up on the Department of Health and Human Services Office of Inspector General's work plan for 2005. "It wasn't just the modifier being used incorrectly, it was that [...]