Wiki Modifier 59 again

[LORA CRAWFORD]

Is there any rule of thumb as to which code modifier 59 would be appended to? Is it the higher RVU lower RVU or something completely different? We work with Encoder pro and I'm trying to figure out for my own knowledge so I don't always have to depend on a program.
Thanks so very much.
Lora

 

[ana marie carter]

Lower RVU. Please check out this website:
https://www.highmarkmedicareservices.com/ > click to Frequently Asked Questions (on the left side) > Outreach & Education (on the left side) > Webinars
This will take you to Upcoming Webinars and Previous Webinars. There's a webinar today on the topic of Modifiers. You can still get the handout. I think this will help clarify on how to use modifiers. May I suggest to sign up so you can get future email of upcoming events/webinar, it's a great way to get AAPC CEUs, and share with your co-workers for coding roundtable meetings. Hope this helped.

 

[mitchellde]

I am going to disagree,
the lower RVU is not alway the correct answer. In the case of a component of comprehensive paring the 59 goes on the component code (the one that would be bundled), and that is not necessarily the one with the lower RVU.

 

[SCanterbury]

Debra is correct. Per CMS' NCCI Manual, Chapter 1:

"Each edit has a column one and column two HCPCS/CPT code. If a provider reports the two codes of an edit pair, the column two code is denied, and the column one code is eligible for payment. However, if it is clinically appropriate to utilize an NCCI-associated modifier, both the column one and column two codes are eligible for payment."​

The "column two code" (formerly referred to as the "component code") needs the modifier to protect it, and it will not always have the lesser RVU value, for the same reason that CMS decided to stop calling it the "component code," which was:

"When the NCCI was first established and during its early years, the “Column One/Column Two Correct Coding Edit Table” was termed the “Comprehensive/Component Edit Table”. This latter terminology was a misnomer. Although the column two code is often a component of a more comprehensive column one code, this relationship is not true for many edits. In the latter type of edit the code pair edit simply represents two codes that should not be reported together."​

If you were to bill two codes for which an edit exists together, and you put a Modifier 59 on the column one code, the column two code would still be denied, since that was the one subject to a denial and needing protection.

Seth Canterbury, CPC, ACS-EM