Wiki Dumb question: is the 59 modifier required for facility billing

[SarahSee1114]

Example so that IV admin codes don't bundle with CT scans, such as 96365 and 74177 or 96372 and 91275. Any advice and/or source info would be appreciated!

 

[thomas7331]

Yes, the 59 modifier works the same way for facility coding as for professional. NCCI publishes a set of tables of the code pairs that trigger the edits for facility which is slightly different that the professional code tables, but for the most part the same rules apply. Of course, documentation must support the modifier in either case.

In your examples, if your infusion or injection is for the contrast or imaging material or for the IV fluids to start or keep the line open, then it should not be coded and a modifier would be inappropriate, but for therapeutic infusions/injections that are unrelated to the imaging, a modifier 59 is appropriate and necessary.