Radiology Coding Alert

Use mod -59 for procedures you don't normally report together When your radiologist takes x-rays on the same patient in different sessions on the same day, do you always report only one code? If the radiologist provides multiple ultrasounds in the same session, do you assume that only one procedure is reportable? If you answered "yes" to either of these questions, you may not be taking advantage of all situations when you can use modifiers -59 and -51. Read on for more information on these modifiers to help you when reporting related codes on the same claim. Use Mod -59 When Codes Are Close Radiology coders use modifier -59 (Distinct procedural service) to identify procedures that are distinctly separate from any other procedure or service the physician provides on the same date.

In general, radiology coders append modifier -59 to procedure codes when the radiologist:   sees a patient during a different session;
treats a different site or organ system;
sees a patient during a different encounter;
treats a different organ system, or
treats a separate injury.   Modifier -59 is "used when multiple procedures in the same (code areas) are performed at the same time," says Linda Parks, MA, CPC, CMC, CCP, coding specialist in Marietta, Ga. Example: Let's say a patient is referred to the radiologist for an x-ray of the abdomen at 10:15 a.m. The radiologist takes a single view and the patient leaves. At 4:33 p.m. the same day, the patient returns with a worsened abdominal condition. This time, the radiologist takes a complete abdomen x-ray with erect and chest views. The claim for this example should read:   CPT 74022 (Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest)
CPT 74000 ( ... single anteroposterior view) with modifier -59 to show there were two distinctly different x-ray sessions.   Pay Attention To Coding Initiative Edits Parks reminds coders to stay on top of the National Correct Coding Initiative (NCCI) edits, so you're always aware of which codes are modifier -59 exempt. Not sure on NCCI? If you're stuck on whether you should bill codes with the -59 modifier, check the NCCI edits. If the codes you are reporting have indicators of "1" next to them, this means you can append the modifier to bypass the edit. If the code has an indicator of "0," you cannot bypass the edit. The NCCI edits change quarterly, so be sure to keep abreast of all updates.

Time Saver: Increase your mod -59 reimbursement rate by appending it only when absolutely necessary, experts recommend.
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