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Modifier 59 with two "separate procedures"

  1. Default Cpc
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    I work for an ER physician billing company as an A/R Specialist. The billers have been appending modifier 59 to CPT code 93010 along with the ER visit 99282-99285. Is this a correct use of the modifier to get the 93010 paid or should there just be a modifier 25 appended to the visit? Many insurers are denying payment stating that the 93010 is part of another service.

    Merlinda Craig, CPC

  2. #12
    It's probably something else that's being billed, because it shouldn't bundle to the E/M...are you billing another type of EKG, like 93000, or another service from the medicine section?

  3. Question 43235 and 31505

    Can we bill the two CPT's 43235 and 31505 with Mod-59? If not, please elaborate the medical reason behind it. As per Encoder these two CPT's are Separate Procedures, but no modifier is allowed.

    Kindly assist.

  4. Default
    The provider has to move the scope past the larynx in order to performed the EGD; the laryngoscopy is a part of the EGD and that is why it is not separately payable.

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