Wiki modifier 59 or 77

[dgiangrande@paof.com]

We have many female patients who see their primary care physician for a routine general physical on the same day that she sees her OB/GYN for a Well Woman.

The insurance company is denying these as "Duplicate Claims" when we file the claim. Which is the correct modifier to use to indicate that these are separate encounters with different physicians billing with the same CPT code, for instance 99394? The physicians are billing with the same Tax ID# as they are in a group.

I have been told to use modifier 59 or 77 but I do not see how either apply based on the definition?

Thank you!

 

[Walker22]

Mod-59 would be the one to use. 77 is for procedure codes only.

ADDENDUM: after further thought, I don't think -59 is correct either. Mod-25 maybe? The description says ".... on the same day as the procedure or other service". The other service could be an E&M visit, can't it?
Someone help us out here! LOL

 

[FTessaBartels]

Different specialties

If they are of different specialties they should not need any modifier. Check to see that they are properly credentialed with the payer.

If the carrier insists on a modifier then -25 is the way to go.

F Tessa Bartels, CPC, CEMC

 

[glendachurch]

miod 59 for range of motion and muscle testing

I am working for an ortho doctor and we do a lot of range of motion and muscle testing for our workers comp patient. My question is some payers pay us some we don't get paid including Medicare. Do we still have to use mod 59 for ROM and muscle testing?

Thanks,

 

[MWilliams01]

This may be more of an insurance benefit limit than anything else. Many policies will only pay for one "annual" exam in a 12 month period. One would have to arugue the necessity for two complete annual exams performed in one day. Obtaining a Pap smear alone would not warrant billing a preventive exam.....just playing devil's advocate.