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Wiki BCBS policy - 59 modifier question

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CSFHC

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Hi all,

I am receiving a bunch of denials on claims with multiple procedures and the use of a 59. I highlighted the area that I am not super clear the meaning. Does anyone have a clear interpretation of this? The link is the full article, page 4 is the Correct coding update.


1780684197435.png
 
CSFHC said:
Hi all,

I am receiving a bunch of denials on claims with multiple procedures and the use of a 59. I highlighted the area that I am not super clear the meaning. Does anyone have a clear interpretation of this? The link is the full article, page 4 is the Correct coding update.


View attachment 9111
Click to expand...


That's saying it would be an error to use a Modifier 59 if the only other service on the claim was an E/M charge. That's why it was given as an example of incorrect reporting.


1780686059912.png



Say a patient had an office visit and a skin biopsy the same day. Those were the only services on the claim. Let's assume for the sake of this example that the office visit does legitimately qualify for Modifier 25.

Wrong:

99214-25
11102-59

Wrong:
99214
11102-59

Right:

99214-25
11102
 
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