ED Coding and Reimbursement Alert

Question: I've heard that in order to bill both an EKG and rhythm strip in the same visit, we need to append modifier -59 to the rhythm strip (first making sure they were done at separate times, so as not to unbundle the procedure). Is the need for the modifier payer-specific or is it true for insurers across the board?

New Hampshire Subscriber

Answer: Whether you need to append modifier -59 (Distinct procedural service) depends on the individual carrier. But regardless of payer, your practice should be wary of purposely performing procedures "at separate times" for payment reasons. If the physician hasn't documented a medically necessary reason for both tests, the payer could very easily imply that you were attempting to game the system.

If the doctor legitimately performed the second test -- and your documentation shows medical necessity for both the electrocardiogram and the rhythm strip that the emergency department physician interprets -- you could append -59 to the second procedure. While you're not reporting the same CPT code for both tests, the rhythm strip is part of the EKG, and you'll want to let the insurer know you're not just repeating the same test.