93005 and 93017 w/mod 25?

[mollie]

We've run into quite some debate on this particular subject. So the question is since 93005 is a component of 93017 but the results of the EKG is what prompted the treadmill later can/should these be billed with a modifier 25?

Thanks,
Mollie

 

[thompsonsyl]

Hi,

I don't believe that modifier 25 can be utilized on codes other than those considered e/m. Also, according to cci, 93005 is a component of 93017 w/ an indicator of (1). This would mean that in order to unbundle the two, you would append a (59) modifier to the 93005.

Hope this info helps & Good Luck!

 

[mollie]

oops, my bad...I meant modifier 59. We are utilizing the 59 for this scenario but are being told by an outside consultant we are overusing this modifier. I feel it is entirely appropriate for this scenario though. Any thoughts?

 

[thompsonsyl]

Hi,

I think that overall there probably is a high use of the (-59) modifier. When there has been a question as to when to unbundle procedures, I've gone right to my physician(s). Ask him if there is justified reason for unbundling the two procedures - show him the description of the (-59) modifier out of the cpt book and give him your scenario. I've worked with physicians who, after reviewing a coding scenario and the use of various "unbundling" modifiers (-25, -57, -59) have stated that it would not be appropriate to bill w/ them. Would this work in your situation?