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Thread: Usage of modifier -25 and -59

  1. #1
    Join Date
    Apr 2007
    Posts
    42

    Default Usage of modifier -25 and -59

    Good afternoon everyone,

    Please advise, should coders be adding a modifier -59 to every procedure when an E/M is being performed on the same day – for Medicare and / or Commercial carriers: Example below: all performed on the same day

    Hospital or Office E/M with a modifier -25
    EKG – modifier -59
    Echo – modifier -59
    and a stress test - modifier -59

    To me this appears to be overutlizing the modifier -59 however I’m told this is how we should billing.

    Your thoughts and knowledge are welcomed!!

  2. #2
    Join Date
    Apr 2007
    Location
    Green Bay
    Posts
    401

    Default

    Quote Originally Posted by Summer View Post
    Good afternoon everyone,

    Please advise, should coders be adding a modifier -59 to every procedure when an E/M is being performed on the same day – for Medicare and / or Commercial carriers: Example below: all performed on the same day

    Hospital or Office E/M with a modifier -25
    EKG – modifier -59
    Echo – modifier -59
    and a stress test - modifier -59

    To me this appears to be overutlizing the modifier -59 however I’m told this is how we should billing.

    Your thoughts and knowledge are welcomed!!
    Well, you would need the modifier 25 on the E/M because of the stress test on the same day. The EKG would need the -59 because of the stress test on same day as well. The echo and stress test, though, don't need any modifiers.

    Of course documentation has to support your billing of the E/M and EKG separately with the -25 and -59.

    Jessica CPC, CCC

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