Wiki Usage of modifier -25 and -59

[Summer]

Good afternoon everyone,

Please advise, should coders be adding a modifier -59 to every procedure when an E/M is being performed on the same day – for Medicare and / or Commercial carriers: Example below: all performed on the same day

Hospital or Office E/M with a modifier -25
EKG – modifier -59
Echo – modifier -59
and a stress test - modifier -59

To me this appears to be overutlizing the modifier -59 however I'm told this is how we should billing.

Your thoughts and knowledge are welcomed!!

 

[Jess1125]

Good afternoon everyone,

Please advise, should coders be adding a modifier -59 to every procedure when an E/M is being performed on the same day – for Medicare and / or Commercial carriers: Example below: all performed on the same day

Hospital or Office E/M with a modifier -25
EKG – modifier -59
Echo – modifier -59
and a stress test - modifier -59

To me this appears to be overutlizing the modifier -59 however I'm told this is how we should billing.

Your thoughts and knowledge are welcomed!!

Well, you would need the modifier 25 on the E/M because of the stress test on the same day. The EKG would need the -59 because of the stress test on same day as well. The echo and stress test, though, don't need any modifiers.

Of course documentation has to support your billing of the E/M and EKG separately with the -25 and -59.

Jessica CPC, CCC