Reader Question:
Use Modifier 59 To Represent A Different Session Or Patient Encounter
Published on Mon Oct 10, 2011
Question: The physician saw a patient, who had chicken bone stuck in his throat in the ER and did 31575, 92511. Later, the doctor brought him to the OR to perform 31530 and 43200.South Dakota SubscriberAnswer: Assuming the documentation supports a significantly separately identifiable E/M service from the procedures, you should bill the case this way:99284-25 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity) appended by modifier 25 (Significant and Separately Identifiable E/M on the same day as a procedure) to indicate that the physician performed and documented an E/M service that was separate from the minor procedures done on the same day. 92511-59 (Nasopharyngoscopy with endoscope [separate procedure]) appended by modifier 59 (Distinct procedural service) for nasopharyngoscopy in the ER for separate encounter31530 (Laryngoscopy, direct, operative, with [...]
