Neurology & Pain Management Coding Alert

Physicians, coders and payers alike often have trouble distinguishing between modifiers -59 (Distinct procedural service) and -51 (Multiple procedures) because they have similar applications. But a quick review of coding guidelines and as a last resort, a well-placed call to the insurer can help you choose between the modifiers with confidence. Use -59 to Unbundle CPT specifies that you should use modifier -59 to indicate a procedure or service that is distinct or independent from other services performed on the same day and, further, that the two services/procedures are not normally reported together, but are appropriate under the circumstances. Specifically, CPT allows you to apply modifier -59 in five situations:
 
 1. Procedures performed at different sessions or encounters
 2. Procedures performed at different sites or organ systems
 3. Procedures performed at separate incisions/excisions
 4. Procedures performed at separate lesions
 5. Procedures performed at separate injuries. Two procedures may correspond to different diagnoses, but not necessarily so, and modifier -59 never applies to E/M services. General coding principles dictate that you may report only one E/M service per day and that modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), rather than modifier -59, applies when reporting an E/M service and another, non-E/M service on the same day.
 
In a neurology practice, modifier -59 is most useful in unbundling edits set forth by the National Correct Coding Initiative (NCCI). For instance, NCCI bundles 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) to 95903 (... motor, with F-wave study). If the physician performs a nerve conduction study (NCS) without F-waves at the same time but on a different nerve (for example, ulnar versus median) as an NCS with F-waves (for instance, during diagnostic testing for carpal tunnel syndrome), you may bill 95900 in addition to 95903 if you append modifier -59 to the former (that is, the component code) to indicate a separate anatomic location. In this case, the insurer should reimburse 95900 and 95903 separately.
 
As a second example, biofeedback (90911) involves electromyography (EMG) procedures 95860-95872 to detect and record muscle activity. Therefore, if the physician administers an additional EMG as a separate medically necessary service for the diagnosis or follow-up of organic muscle dysfunction, bill the appropriate EMG code(s) with modifier -59 appended to indicate a separately identifiable diagnostic service with 90911.
 
Note: Always attach the modifier to the column 2 or component (secondary) code, not the column 1 or primary procedure code. You may report only NCCI edits with a 1 status indicator using modifier -59. You may not unbundle code combinations with a status indicator of 0 under any circumstances. Watch Your -59 Payments Generally, [...]