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Ob-Gyn Coding Alert

Modifiers:

2 Tips Show You How to Avoid Putting Modifier 59 on the Wrong Code

Published on Mon May 21, 2012

This ob-gyn example will demonstrate both incorrect and correct solutions.Although you may be in the midst of planning your summer vacation, you can't be lax about your modifier 59 (Distinct procedural service) claims. Carriers are still scrutinizing submissions for separate and distinct services, thanks to the OIG's error rates. But you can prevent paybacks by using these two tips.Tip 1: Determine Separate RegionsPull a sample of your modifier 59 submissions and verify that the claims properly represent a distinct procedural service. Fifteen percent of the OIG's audited claims using modifier 59 had procedures that weren't distinct because "they were performed at the same session, same anatomical site, and/or through the same incision," says Daniel R. Levinson, inspector general, in "Use of Modifier 59 to Bypass Medicare's Correct Coding Initiative Edits," an article posted on the OIG Web site www.oig.hhs.gov/oei/reports/oei-03-02-00771.pdf. Rule of thumb: Make sure the physician is working in [...]
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