Cardiology Coding Alert

Question: Can you explain when to choose modifier 59 and modifier 76?

Georgia Subscriber

Answer: For your J10 Part B MAC Cahaba, you should use modifier 59 (Distinct procedural service) only to override a Correct Coding Initiative (CCI) edit (when breaking the edit is appropriate). This policy became effective July 1, 2013.

CMS provides an example in its Modifier 59 Article that may help. CCI bundles 93040 (Rhythm ECG, 1-3 leads; with interpretation and report) into 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report) because an ECG is an expected part of a stress test. But if the 93040 service is performed at a different patient encounter than the stress test for an unrelated reason, then you may report 93015 and 93040-59.

Mod 76: If the physician repeats a service (meaning the same code is appropriate for each service), then you should report that code once for each service and append a repeat procedure modifier, such as 76 (Repeat procedure or service by same physician or other qualified health care professional). As an example Cahaba indicates proper coding for two chest X-rays (71020, Radiologic examination, chest, 2 views, frontal and lateral) on the same date would be:

• Line item 1: 71020
• Line item 2: 71020-76.

Resources: The Cahaba notice is online at www.cahabagba.com/news/changes-to-modifier-59-important-notice/. To learn more about proper modifier 59 use, review the Modifier 59 Article in the Downloads section at www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.