You ONLY bill CPT's labeled (separate procedures) when they are the only thing done, or there is STRONG evidence that it is unrelated to ANY other procedure billed that day. IF medical records support biling the code separately (and that's a HUGE if), then it would require a 59 modifier to acknowledge that it's a distinct procedural service (yes, it's the 59 every time). Do NOT just tack one on to get the code paid; that could end up costing more in the end if you were audited. Please see this artice:
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