Wiki MODIFIER 59 with 96372

[tera828@yahoo.com]

I need a written rationale to explain to my charge entry person on why a 59 modifier is not to be used with 96372.

I have looked at the NCCI and see no listing of a 59 modifier needed. The only thing is I draw a blank on how to word they "WHY".

Can someone please help me with composing the answer to "WHY" or provide the information. I do not have AAPC Coding software available to me.

I do not want audits for over-use of the 59 modifier.

 

[thomas7331]

In what situation is your charge entry employee adding the modifier? You will not find anything stating that this modifier is not to be used with CPT code 96372 because there is no such rule, and in fact there are situations in which the modifier is required. But whether or not a modifier 59 is appropriate on this code would depend on what other services are billed by the provider on the same date of service.

 

[SharonCollachi]

Here is one article from aapc showing when it SHOULD be used.