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Different Encounter Definition

  1. #1
    Smile Different Encounter Definition
    Medical Coding Books
    There is some confusion over the -59 modifier definition of "different encounter". For example, according to CCI you can append this modifier to CPT 92587 if done at sane day as an E/M...Now, since audiologist does the hearing, and not the physician, does this warrant a different encounter? Could someone better explain the definition of "different encounter?"

    Thanks

  2. #2
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    Quote Originally Posted by misbell View Post
    There is some confusion over the -59 modifier definition of "different encounter". For example, according to CCI you can append this modifier to CPT 92587 if done at sane day as an E/M...Now, since audiologist does the hearing, and not the physician, does this warrant a different encounter? Could someone better explain the definition of "different encounter?"

    Thanks
    If the audiologist bills separately from the physician, then there's no need to add a modifier to either.

  3. #3
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    Actually no. The physician is billing for both. Hence, that is where the CCI edit comes into play.

  4. #4
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    Quote Originally Posted by misbell View Post
    Actually no. The physician is billing for both. Hence, that is where the CCI edit comes into play.
    Well, it's not a CCI edit. There is a CPT guideline that says "Hearing tests (such as whispered voice, tuning fork) that are part of otorhinolaryngologic Evaluation and Management services are not reported separately. (Basically, the "hearing test" bullet from the 1997 exam can't be billed as a separate procedure).

    Under the main category (Special Otorhinolaryngologic Services), the guidelines also state: " Special otorhinolaryngologic services are those diagnostic and treatment services not included in an Evaluation and Management service. These services are reported separately, using codes 92502-92700."

    That tells me that you shouldn't need a modifier to get both to pay on the same DOS. It's not included in the E/M (or vice versa), so there's no need to add a modifier to distinguish between the two. If you've gotten a denial (especially for an NCCI edit or on CPT guidelines), it's probably incorrect, and should be appealed.

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