Wiki 59 mod on anesthesia w/procedure

[ljhaley@gmail.com]

Hi everyone!
It's "routine" in this office to add a 59 mod when using anesthesia code 64435whenever we did a endometrial biospy (58100) or other types of ob/gyn surgeries done by the practice. While I see the CCI says use 00940 instead of 64435 for the endo biopsy 58100 now, but I would really like to know if it's appropriate to add the modifier. Shouldn't the anesthesia code be able to stand on it's own? The girls here say " no mod, no pymt"-but I'd like to know what's "right" to do-thanks!

 

[mcnaryk]

Hi there! I gather from your question that you're billing the OB/GYN charges-I used to do that but now work in an anesthesia billing office so I understand both sides to this question. I agree that 64435 should be able to stand alone from the biospy 58100 code and NOT require modifier 59-it's two completely different services being provided. I don't think it would hurt to have the modifier, just to really make it clear to the payer that the OB/GYN did both the block and the procedure, but I disagree with the 'no mod, no pmt'. CCI suggestion to use 00940 is for the anesthesiolgist to bill if the patient were put under anesthesia-from your question I am thinking this is a procedure being done in the office. Hope this helps-thanks!

 

[ljhaley@gmail.com]

Thanks! It helps A LOT!!!