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New
Cahaba Medicare has again announced an 'important change with modifier 59', and in a call to 'clarify' really muddied the waters rather than clarifying anything. This announcement took place before - in late 2009 - and was rescinded within 30 days.
A major reference to their reasoning for the change is post reduction or post intubation x-rays. Clearly someone is not familiar with the definitions of the modifiers and has not referred to the NCCI manual:
"3. When limited comparative radiographic studies are performed (e.g., post-reduction, post-intubation, post-catheter placement, etc.), the CPT code for the radiographic series should be reported with modifier 52 indicating that a reduced level of interpretive service was provided. This requirement does not apply to OPPS services reported by hospitals."
In addition, 76 and 77-per definition, do not bypass NCCI bundling edits:
“Modifiers 76 (“repeat procedure or service by same physician”) and 77 (“repeat procedure by another physician”) are not NCCI-associated modifiers. Use of either of these modifiers does not bypass an NCCI edit.”
Unless these definitions are supposed to be changing as well, I hope this change is rescinded again. If the NCCI manual were not so specific, I could almost understand the radiology, but the other references made in the call last Thursday to joint injections and spine procedures are just plain misinterpretations of CPT and NCCI coding and could cause some major reimbursement issues in the Medicare and Medicare Advantage processing.
A major reference to their reasoning for the change is post reduction or post intubation x-rays. Clearly someone is not familiar with the definitions of the modifiers and has not referred to the NCCI manual:
"3. When limited comparative radiographic studies are performed (e.g., post-reduction, post-intubation, post-catheter placement, etc.), the CPT code for the radiographic series should be reported with modifier 52 indicating that a reduced level of interpretive service was provided. This requirement does not apply to OPPS services reported by hospitals."
In addition, 76 and 77-per definition, do not bypass NCCI bundling edits:
“Modifiers 76 (“repeat procedure or service by same physician”) and 77 (“repeat procedure by another physician”) are not NCCI-associated modifiers. Use of either of these modifiers does not bypass an NCCI edit.”
Unless these definitions are supposed to be changing as well, I hope this change is rescinded again. If the NCCI manual were not so specific, I could almost understand the radiology, but the other references made in the call last Thursday to joint injections and spine procedures are just plain misinterpretations of CPT and NCCI coding and could cause some major reimbursement issues in the Medicare and Medicare Advantage processing.