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Thread: use of modifier 59 on pulmonary procedures

  1. #1
    Join Date
    Apr 2007

    Default use of modifier 59 on pulmonary procedures

    AAPC: Back to School
    use of 59 modifier on pulmonary procedures


    We have a situation in our Pedicatric doctors office verses our billing office. we bill a 94760 oxygen sat single with an E/M-25 only. our billing office have the system set up to edit the pulse oximetry to add the 59 modifier. i don't think i should be adding the 59 modifier on the first procedure line and it's the only procedure. our billing office says it's per the insurance guidelines, policies and from the appeals of denied claims to justify adding the 59 modifier. Should I be concern about this? Will this put our Pediactric office in jeopardy of an audit?

  2. #2
    Join Date
    Apr 2007
    Kokomo, IN

    Default pulmonary procedures

    I thought the 94760 was bundled into any other procedure OR E/M done on that day. Anyone else?

  3. #3
    Join Date
    Apr 2007
    North Carolina



    I agree with you. Most of our carriers bundle this with the E/M code. Below is a reference....


  4. #4
    Join Date
    Apr 2007
    lauderdale lakes


    its bundled- i have never been paid for it. neither has anyone i know.

  5. #5


    I agree, we never got any payment for the pulse ox., but we did receive payment for the aerosol treatments, by using a 59.

  6. #6
    Join Date
    Apr 2007



    I thought since 2007 Pulse Ox is only payable when it is a Facility bill and not on Professional because it's a Technical Component only?


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