Ob-Gyn Coding Alert

Consider modifier 59 a last resort, not your first option

Suppose your ob-gyn performs a puncture aspiration of a breast cyst (19100, Biopsy of breast; percutaneous, needle core, not using imaging guidance [separate procedure]) but also does a breast exam. You want to report the exam separately, so you append modifier 59 (Distinct procedural service) and hope for the best, right?

Wrong. You should in fact append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code (such as established patient, 99214).  Use this handy tool to decipher which modifier to select while avoiding unnecessary slip-ups - and submit clean claims every time.