Cardiology Coding Alert

Never append modifier 59 to an E/M service.

It's important to pay attention to modifier indicators as you're looking through the Correct Coding Initiative (CCI) edits. When the modifier indicator is "0," remember this means you cannot break an edit under any circumstances.

On the other hand, a modifier indicator of "1" lets you know that an edit can be overcome, if appropriate, with the use of a modifier, such as modifier 59. However, just because you can add a modifier, this doesn't mean you should. Be sure you have the supporting documentation for requesting payment for both codes before adding a modifier to the bundled pair.

"Modifier 59 and other CCI-associated modifiers should not be used to bypass a CCI edit unless the proper criteria for use of the modifier 59 are met," Mary I. Falbo, MBA, CPC, president and CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania, adds. "Documentation in the medical record must satisfy the criteria required by any CCI-associated modifier that is used."

Example: You can use modifier 59 when the surgeon performs the bundled procedures for different anatomic sites/regions, different organs, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ, Falbo explains.

Caution: You should never append modifier 59 to an evaluation and management (E/M) service.

Instead, modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) would be appropriate to append to E/M services performed on the same day if a significantly separately identified E/M is provided, says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC's Certified Cardiology Coder steering committee.