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foley insertion in the ED

  1. #1
    Exclamation foley insertion in the ED
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    In the ED, if a foley is inserted and an EKG or infusion is done, i get the following edits. Is it appropriate to use a modifier -59 on these to clear the edit? See below:

    You have coded 51702 in addition to the following code(s):
    (36400, 36405, 36406, 36420, 36425, 36430, 36440, 36600, 93000, 93005, 93010, 93040--93042, 93318, 94002, 94200, 94250, 94680, 94681, 94690, 94770, 95812, 95813, 95816, 95819, 95822, 95829, 95955, 96360, 96365, 96372, 96374--96376, 99148--99150).

    The Medicare NCC edits consider this separate reporting of codes that are components of the comprehensive procedure if billed for services provided to the same beneficiary by the same physician on the same day.

    These codes will be rebundled by your Medicare payor and payment will be based on code 51702 only.

    * If these codes represent a different session, surgery, site, lesion, or injury, then use of an appropriate modifier on the excluded code will differentiate the services provided and will notify the payor to bypass this edit.

  2. Default
    We do not code for EKG's in facility, but when we have a foley with an infusion, hydration or injection, we always have to put modifier 59 on the infusion, hydration or injection. I honestly do not understand why, but that is just the way it is I guess.

  3. #3
    If in the ED, then use the -25 on the E&M and you should be all set

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