Urology Coding Alert

Watch out: If you override every ‘1' bundle, you're asking for trouble. During the same operative session, your urologist performs two separate procedures that the Correct Coding Initiative ( CCI Edits ) bundles with a status indicator of "1," so you can automatically break the bundle using modifier 59 (Distinct procedural service) -- correct? Think again. Even veteran coders can fall into the modifier 59 trap. You should not automatically append modifier 59 just because CCI puts a modifier indicator of "1" on a bundle, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians (UWP) Compliance Program. Modifier 59 is actually the "modifier of last resort," Bucknam explains. Here's why: Incorrectly unbundling without proper documentation can result in payback requests and accusations of fraud. This handy flowchart will help you determine your modifier options and select the right modifiers when [...]