Orthopedic Coding Alert

Question: Our payer is denying a claim involving an E/M and a fine needle aspiration (FNA) of a bone lesion with modifier 59 for an improper modifier. Is my modifier use appropriate? California Subscriber Answer: Most payers, including Medicare carriers, require modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on an E/M service reported with a minor procedure, such as an FNA of a bone lesion. You should consider procedures with a 0- or 10-day global period as minor procedures -- FNA code 10021 (Fine needle aspiration; without imaging guidance) has 0 global days. Caution: Don't just put a modifier on your E/M visit code to get paid. Make sure your E/M is a significant, separately identifiable service from the minor E/M service that payers associate with the procedure. CPT considers minor procedures to have [...]