Gastroenterology Coding Alert

• Never append modifier 59 to any E/M service code. It's for procedures only.

• CPT instructions indicate that you should not report modifier 59 if another, more specific modifier, like modifiers 58 (Staged or related procedure or service by the same physician during the postoperative period), 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period), 79 (Unrelated procedure or service by the same physician during the postoperative period), or 91 (Repeat clinical diagnostic laboratory test) describes the separate patient encounter or session better.

• Do not automatically append modifier 59 to the second listed procedure. CCI editors bundle procedures they consider mutually exclusive or integral to more extensive procedures. It's not technically a matter of timing or the value of the procedures, though more extensive procedures will be valued higher than less extensive ones.

When procedures are performed together that are basically the same, or performed on the same site but are qualified by an increased level of complexity, the less extensive procedure is included in the more extensive procedure.