Wiki use of 59 modifer

[imonii]

We bill 95861, 95900 59, 95903,95904, 95926 95934,95936- both lower and upper. my doctor was told we shouldnt use the 59 modifer on the 95900 it may cause an audit we have billed it this way for a few years, I know we should be care with use of 59 modifer, will this cause an audit, does anyone know if we can bill this procedure with the 59 modifer? 95900 is a colum 2 code for 95903 but a modifer is allowed in order to differnitae between the services provided. Does anyone know if we remove the 59 from the 95900 will it pay less? or at all


Thanks
Imonii,CMBS

 

[abyrne]

If you remove the 59 modifier, the service will be denied. CCI edits do allow cpt 95900 to be billed with 95903 if you apply the 59 modifier to 95900. CMS has indicated that they are monitoring the use of the 59 modifier because of the frequent use. However, if the documentation supports the different tests, then you should bill both codes. Be sure to verify the test report to be sure that the different tests were done.

 

[IHMBilling]

Two doctors scrubbed in to preform wound exploration and irrigation. Would modifier 62 be appropriate?

 

[csperoni]

Two doctors scrubbed in to preform wound exploration and irrigation. Would modifier 62 be appropriate?

The code must allow -62. The physicians must be of different specialties. Each must complete an op note and include the medical necessity of co-surgeons.

https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144538