Wiki modifier 59

[rkonert]

Mercy Care is denying payment for consults/follow-ups submitted with same day echo although we use 25 modifier on E&M code. We were told that we need to use modifier 59 on the echo because they are using McKesson Claim check. There is no other test done that day so 59 does not meet it's criteria here. I don't feel comfortible as a coder using 59 modifier only because Mercy Care has a glitch in their system. Had anybody else have the same problem?

 

[Jess1125]

Mercy Care is denying payment for consults/follow-ups submitted with same day echo although we use 25 modifier on E&M code. We were told that we need to use modifier 59 on the echo because they are using McKesson Claim check. There is no other test done that day so 59 does not meet it's criteria here. I don't feel comfortible as a coder using 59 modifier only because Mercy Care has a glitch in their system. Had anybody else have the same problem?

I've run into insurances as of late denying when an echo is done the same day as an E/M service. I'm having the insurance department send in an appeal along with guidelines from the E/M section stating that diagnostic testing can be billed separately from the E/M. I'm NOT putting any modifier on the echo code.

Jessica CPC, CCC