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modifier 59 for facility charging/coding

  1. Question modifier 59 for facility charging/coding
    Exam Training Packages
    Do you put a modifier 59 on 36000?
    On infusions/injections, where does modifier 59 go? Do you put 59 on the initial injection/infusion, or does the modifier go on the sequential push/injection?
    See examples below:

    Example 1:
    96374-59
    96375
    96375:

    Example 2:
    96374
    96375-59
    96375-59

    Example 3:
    96365-59
    96368
    96367

    Example 4:
    96365
    96368-59
    96367-59

    Please help me clarify which one of these examples are correct.

  2. #2
    Location
    Jacksonville Florida Chapter
    Posts
    205
    Default
    This all depends on if the procedures can be defined as distinct from each other per the patient's medical record.

    For your examples 1 and 2....

    If the IV pushes were done in different sessions, then you'd put the modifer on the sessions that were different from one another. I.E. If 96374 was done on a seperate day from both 96375, then you'd code 96374 for the first day and 96375-59 twice for the second day.

    Another way to use mod -59 is if the same procedure is done on a different body part or organ.

    If an IV push is given with more than one substance on the same day, you're not going to be able to use mod -59 because the nurse/doctor will not remove the IV for each push only to place the needle somewhere else. Once an IV is in, it's usually in until all treatments are done. If this were true, then you would code without the use of mod -59.

    The same would go for your examples 3 and 4.

    Hope this helps.
    John Meyer, CPC
    Heekin Clinic

  3. #3
    Location
    Columbia, MO
    Posts
    12,557
    Default
    Quote Originally Posted by colna65 View Post
    Do you put a modifier 59 on 36000?
    On infusions/injections, where does modifier 59 go? Do you put 59 on the initial injection/infusion, or does the modifier go on the sequential push/injection?
    See examples below:

    Example 1:
    96374-59
    96375
    96375:

    Example 2:
    96374
    96375-59
    96375-59

    Example 3:
    96365-59
    96368
    96367

    Example 4:
    96365
    96368-59
    96367-59

    Please help me clarify which one of these examples are correct.
    None of the examples you have provided is coded correct.
    you do not use the 59 on the initial code unless there would be other codes besides these that would warrant this. Add on codes do not need modifiers as they are already designiated as add on, except when you have multiples of the same code then a 59 is need on the second and subsequent of the same code. Not knowing the documentation and going strait from the numbers you provided
    #1 and # 2 96374
    96375
    96375 59
    #3 and #4 96365
    96367
    96368
    However the documentation may change how this should be coded.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default Modifier 59 and injections and hydrations
    I am getting edits that want to use modifier -59 on 96372 with hydration 96360 and 96361.
    Also use modifiers on a injection with IV infusions. Can some please clarify on this?

  5. #5
    Default
    Whenever you use 96372 in conjunction with any other infusions, hydrations or IV pushes, you will need to add the -59 modifier to the 96372. Look in your CPT code book. It explains it to you right in the book. Hope this helps!

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