modifier 59

  1. K

    Modifier 59 and CPT "use with" rules

    I have a provider billing codes 64450 and 77002-59 and am being told that 77002 should be payable since it was billed with a -59 modifier. 77002 does not include 64450 in the "use in conjunction with" code list, so I am thinking it is not an allowable code. Which is correct in this scenario?
  2. A

    blephroplasty and ptosis

    posting Blephroplasty and ptosis repair same day 15823-50,51and 67903 -50 or 15823-50,59 and 67903 -50
  3. C

    51/59 Nerve Block Modifiers - bundling issue

    Hello- I work for a neurology office - having some difficulty with a bundling issue. On an extreme case I could bill for one patient: 64450 64405 20553 64615 96372 How i was trained - typically I would use: 64450 - 50, 59 64405 - 59 20553 64615 96372 - 59 BCBS - pays for all minus 20553 -...
  4. L

    BCBS denying mod 59 on vaccine administration code 90471

    Recently, we have gotten several denials from various BCBS plans for modifier 59 on vaccine administration code 90471. The remark code says "procedure modifier was invalid on date of service". One patient called BCBS and was told modifier 59 is invalid on this service. Is this a glitch within...
  5. D

    Modifier -59 ophthalmological testing

    This was handed down from Corporate, and I plan to dispute this, if I can receive confirmation that the payment modifier usage -59- is in fact erroneous/unnecessary: claim example: 99214 92134 92275 -59 -Lt CPT codes 92134 & 92275 are separate diagnostic tests (SCODI, ERG), so why would...
  6. A

    Modifier XE vs. 59

    I'm looking for guidance on when to use modifier XE vs. modifier 59. For example, an ABA client is seen in the morning for 60 mins for behavior treatment (0364T - first 30 mins & 0365T - additional 30 mins). The client is then also seen later that day for the same service (0365T). Services are...
  7. M

    Ivus-cpt 37525

    Good afternoon, I have had a first today. One of my physicians performed an IVUS of three veins using an access on the right side, then performed three additional ultrasounds from an access on the left side. Since these are two separate access sites, would billing of CPT 37252 with a 59 be...
  8. L

    Modifier 59 on administration codes for injections.

    I work at a Primary Care office and recently have received multiple denials on BCBS claims with vaccine injections. I contacted BCBS and was told that the administration code 90471 (billed with modifier 59) that we use for flu and pneumonia vaccines has "expired as of November 20, 2017". She...
  9. J

    Billing a new pt visit and excision

    The patient's only reason for the visit was for her mass. I am hesitant to bill the E/M with a 59 as there was nothing else addressed. The doctor coded a 99202 and a 27327 both with the same diagnosis of D17.9 I am new to surgical/procedural billing and coding Do I only bill the excision...
  10. K

    Epidurography with Modifier 59

    Okay so I have a lot of information about using 72275 with the 59 modifier when an Epidurography is performed along with an epidural injection. But I just need to know the minimum of what we need for this to be acceptable. I feel like just a separate report and hard copy is not enough and I...
  11. D

    Modifier 59 being billed on every line

    I work for a remote medical billing company who manages 15 clinics. They bill every CPT line with modifier 59 and I think this is wrong. I have been written up because I had taken off the modifier 59 of a surgery when per the NCCI it says none of the codes are bundling. I always check the CCI...
  12. C

    Coding multiple excision on same level

    I am trying to gather resources to help in responding to a provider regarding scope coding. We have a case where two lesions both at the level of the sigmoid were removed, one by snare and one by forceps. The provider feels he can code both 45385 and 45380 and feels that all the respurces I...
  13. A

    -59 Modifier on HCPCS codes

    We are having an issue where Regence is denying the second line of J9055 because "modifier -59 is not valid with HCPCS code J9055." We are billing separate lines to bill 2 different NDC#s. How are we to code the two lines without modifier -59? Do we bill without a modifier or just lump the 2...
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