Reader Question:
Determine Whether You Need Modifier 59
Published on Thu Dec 19, 2013
Question: The patient underwent 99395 25, 81000, 58301 -59, 99406 on the same day. How should I bill these codes?
Codify Subscriber
Answer: You don’t need modifier 59 (Distinct procedural service) with 58301 (Removal of intrauterine device [IUD]). No bundling exists between any of these codes, so you should report:
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99395-25 (Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years; Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service)
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58301
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99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes)
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81000 (Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy)
Keep in mind, however, that code 99406 has some very specific CPT® criteria which must be met before this code can be billed, and that a routine UA is usually denied by the majority of payers as not medically, indicated.