Results 1 to 6 of 6

use of mod 59

  1. Default use of mod 59
    Exam Training Packages
    Hello all I hope someone can help me or point me in the right direction on when to append modifier 59, we are getting so many different answers it isn't funny.. If on an ER charge facility side we have a chest xray along with an injection code do we need a 59 mod on the injection? same question but diff, if we have an ultrasound with an injection and or ekg do we need to append the mod 59 to either or both injection and/or ekg? When we have a xray and just our E/M level do we append mod 25? I am so sorry for all these questions but I am not getting a straight answer from anyone. So I thank everyone for their help..

    Also what web site is a good one to go to and ask these kinds of questions, I tried mcare but I can't seem to navigate it right..thank you again alice

  2. #2
    Location
    Columbia, MO
    Posts
    12,570
    Default
    You do not need a 59 modifier when you have an injection and an xray since the codes are definitely distinct by descriptor they need no further separation. Same thing for an ultrasound and an injection. Basically you need a 59 when you have 2 procedures where one is considered a component of the other or the 2 procedures are considered mutually exclusive, so you need to check both of these files in the CCI edits to be sure. Now as far as the 25 modifier, in the facility you need the 25 modifier on the E&M only when combined with a significant procedure that would be any status S or status T procedure, Chest xrays and EKGs are status X and are not considered significant. Hopefully this will help

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    Quote Originally Posted by alices View Post
    Hello all I hope someone can help me or point me in the right direction on when to append modifier 59, we are getting so many different answers it isn't funny.. If on an ER charge facility side we have a chest xray along with an injection code do we need a 59 mod on the injection? same question but diff, if we have an ultrasound with an injection and or ekg do we need to append the mod 59 to either or both injection and/or ekg? When we have a xray and just our E/M level do we append mod 25? I am so sorry for all these questions but I am not getting a straight answer from anyone. So I thank everyone for their help..

    Also what web site is a good one to go to and ask these kinds of questions, I tried mcare but I can't seem to navigate it right..thank you again alice
    What you need is this: http://www.cms.gov/NationalCorrectCo...CCIEP/list.asp
    Read the overview - it's got instructions...Column 2 codes need mods when billed w/column 1.

    and to answer your question, the only service you listed that would need a modifier is an E/M, if billed w/an injection. EKG's bundle to IPPE's, and CXR's aren't payable w/critical care codes. Hope that helps!

  4. #4
    Location
    Columbia, MO
    Posts
    12,570
    Default
    Quote Originally Posted by btadlock1 View Post
    What you need is this: http://www.cms.gov/NationalCorrectCo...CCIEP/list.asp
    Read the overview - it's got instructions...Column 2 codes need mods when billed w/column 1.

    and to answer your question, the only service you listed that would need a modifier is an E/M, if billed w/an injection. EKG's bundle to IPPE's, and CXR's aren't payable w/critical care codes. Hope that helps!
    Brandi remember that facility CCI edits are different from physician I did not look to see which reference you provided but I just wanted to throw that out there. and facilities do not do the IPPE, just a reminder, actually are great resource for facility is that quarterly transmittal which is usually titled the OPPS update.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    Sorry about that...You need THIS one, then: http://www.cms.gov/NationalCorrectCo....asp#TopOfPage

    I went to 'Physicians' out of habit...

  6. Default re-mod 59
    Thank you so much for the help it is truly appreciated , and I will most definitely look at the websites provided..alice

Similar Threads

  1. Mod 51 vs Mod 59 for ASC use
    By Tracy592 in forum Modifiers
    Replies: 3
    Last Post: 07-08-2015, 01:49 PM
  2. mod 62 denied can I use mod 80?
    By fisher.jaimie@gmail.com in forum Modifiers
    Replies: 6
    Last Post: 05-18-2015, 06:27 AM
  3. Mod 25
    By dpumford in forum Modifiers
    Replies: 2
    Last Post: 09-06-2011, 12:08 PM
  4. mod 25 - Can anyone shed some light on this
    By iovine in forum Billing/Reimbursement
    Replies: 4
    Last Post: 08-26-2011, 07:32 AM
  5. mod 25 & mod 59 with a 94664 (inhaler)
    By jsa1517 in forum Modifiers
    Replies: 2
    Last Post: 01-29-2010, 03:46 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.