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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
 
Another way of saying it: you can't just blanket append or slap a 59 on every code just to try and get it through edits. Especially if you are appending it to a code when it is the single and only code reported on that DOS.
Same idea as when providers slap a 25 on every E/M code.
If you think I am kidding, I am not. o_O🙄
 
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...
For Mississippi BCBS we use modifier XU instead of 59. You may want to try that on a few claims.
 
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