Orthopedic Coding Alert
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This Tool Can Do the Modifier Work for You
Published on Sun Nov 14, 2004
Use a flowchart to determine when modifier -59 best suits the bill Suppose your physician performs two procedures, but the National Correct Coding Initiative (NCCI) bundles the two codes together. You research the code pair and determine that a modifier can separate the edits, and you double-check your physician's documentation to ensure that it reflects the distinct nature of the two services. You append modifier -59 (Distinct procedural service) to the bundled code and hope for the best, right?
Wrong. You should first ensure that no other modifier better suits your claim. Use this handy tool to help you select the right modifier every time. 
Other Articles in this issue of
Orthopedic Coding Alert
- Coding Case Study:
Scrutinize Op Report Before You Bill 29822 With 29826
Not every SLAP lesion debridement claim will warrant separately reporting 29822 If you bemoan coding [...] - Arthroscopic SAD Edits Vary According to Source
Compare AAOS' code pairs with NCCI's before you bill 29826 Orthopedic coders know that you [...] - Using Modifier -59 to Separate All the NCCI Edits? Think Again
The OIG plans to crack down on -59 usage in 2005, so be careful If [...] - You Be the Coder:
How Should We Report a Disk Bulge?
Question: My surgeon's operative report says,"Mild central disk bulge at L4-5 with facet and ligamentum [...] - Reader Questions:
Negative History May Mean No History
Question: When the orthopedist writes, "Past history is negative," would this satisfy the "past history" [...] - Clip and Save:
This Tool Can Do the Modifier Work for You
Use a flowchart to determine when modifier -59 best suits the bill Suppose your physician [...] - Reader Questions:
Stick With Unlisted for Meniscus Trephination
Question: Which code should I report when the orthopedist documents "arthroscopic trephination posterior third medial [...] - Reader Questions:
Look to 99141 for Conscious Sedation
Question: Especially when dealing with young children, our surgeon will administer conscious sedation during difficult [...] - Reader Questions:
Append -24 During Global With Private Payers
Question: If a patient has a postsurgical hematoma during the global period, can we bill [...] - Reader Questions:
New Decubitus Ulcer Codes Shouldn't Be Confusing
Question: I noticed that ICD-9 2005 added an "unspecified site" and "other specified" decubitus ulcer [...] - Reader Questions:
Append -21 to Level-5 E/M Only
Question: Our orthopedist performed a level-three E/M service on a new patient last week. The [...]
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