Wiki Modifier 59 for Wound Care

[kelliep]

Hi all,

I just started billing for our new wound care center. It seems that the various insurances have different views on what modifiers go with what line, and pay accordingly. This leads to a bit of confusion.

I have to use the 25 and 59 modifier alot. I normally have an E/M code with a 25, and then a code of 97597 or 11042. Now, when I have an E/M, 97597 AND 11042, which line does the mod 59 go on? Medicare seems to like it on the 2nd line, and other insurances, the third. For example, I'll have a claim like this:

99213 (25)
97597
11042

Does 59 go with line 2 or 3?

I often have this too:

99213 (25)
97597
97598
11042

On what line should the 59 go on in the above case?

I have encoderpro.com and it says all these codes are 51 exempt so that's out.

I feel I should know the answer but I just need some clarification.

Thanks!
Kellie

 

[espressoguy]

When you have 2 procedures the 59 goes on the one with the lower RVU. In this case, 97597. Also, 97598 is the add-on code for 97597 so it shouldn't need a modifier at all. Unless you have a goofy payer (like I do)

 

[kelliep]

Thank you. And the one with 4 lines?

 

[Evelyn Kim]

the lower 2 RVU procedure would get the 59.