# use of mod 59



## alices (Nov 17, 2011)

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


----------



## mitchellde (Nov 17, 2011)

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


----------



## btadlock1 (Nov 17, 2011)

alices said:


> 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/NationalCorrectCodInitEd/NCCIEP/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!


----------



## mitchellde (Nov 17, 2011)

btadlock1 said:


> What you need is this: http://www.cms.gov/NationalCorrectCodInitEd/NCCIEP/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.


----------



## btadlock1 (Nov 17, 2011)

Sorry about that...You need THIS one, then: http://www.cms.gov/NationalCorrectCodInitEd/NCCIEHOPPS/list.asp#TopOfPage

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


----------



## alices (Nov 19, 2011)

*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


----------

