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General Surgery Coding Alert

Reader Question:

Second Procedures Billed With Modifier -59

Published on Mon May 01, 2000

Question: On occasion, a patient needs both an upper and lower endoscopy (EGD and colonoscopy) for different reasons (e.g., duodenal ulcer and history of polyps or anemia). As a courtesy to the patient, I perform both of these procedures at the same setting, yet reimbursement is always 50 percent on the second endoscopy. What is the correct way to bill for these procedures to get full reimbursement?

Michigan Subscriber  
Answer: Any time multiple procedures are performed on the same day, even if they are designated as distinct by attaching modifier -59 (distinct procedural service) to one of the services, a reduction will be made to the second procedure, says Susan Callaway-Stradley, CPC, CCS-P, a coding and reimbursement specialist in North Augusta, S.C. The only exception, she says, is when the procedure or service already is designated as a list separately in addition to or add-on code, in which case the fee already is reduced.
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