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Thread: Modifier 59

  1. #1
    Join Date
    Apr 2007

    Default Modifier 59

    AAPC: Back to School
    In the past I have used a mod-59 when posting inhalation treatment (94640) or any other Asthma therapy that we do in the office. I append the 59 to the E/M and it was normally getting processed and paid, and it seems like ever since the new year the office visit has been getting denied. Does anyone know if there was an update to mod 59 and if so what Mod should I be using?

  2. #2
    Join Date
    Apr 2007
    North Carolina


    Q What codes should I submit if, during a problem-oriented office visit, I decide the patient requires a nebulizer treatment and the nurse gives the patient instructions on using a nebulizer or metered dose inhaler at home?

    A You should submit the appropriate evaluation and management (E/M) office visit code, the code for the nebulizer treatment (94640, "Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device)"), the code for the nurse's instructions (94664, "Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device") and the correct J code for the supply of the nebulizer drug. You should also add modifier -25 to the E/M code to indicate that it was a significant, separately identifiable service from the other services described.


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