Otolaryngology Coding Alert

Question: How do I determine which code to append modifier -59 to?


New Jersey Subscriber

Answer: You should always use modifier -59 (Distinct procedural service) on the code that is bundled. In other words, append modifier -59 to the component or lesser-valued code. The procedures' order doesn't matter.

For instance, a neonatologist requests an otolaryngologist's opinion regarding a newborn's nosebleed. The otolaryngologist performs a history, examination, and medical decision-making and determines the newborn requires simple anterior nasal packing. The otolaryngologist places packing into the anterior section of the nose.

Later the same day, the neonatologist alerts the otolaryngologist to additional hemorrhaging. The renewed bleeding requires extensive anterior packing.

Problem: The National Correct Coding Initiative (NCCI) bundles limited anterior packing code 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method) into extensive packing code 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method). Because the bleed controls occur in separate sessions, you may report both 30901 and 30903.

Watch out: Avoid the temptation to append modifier -59 to the otolaryngologist's second procedure. You should instead append modifier -59 to 30901, the lesser-valued code (1.64 facility relative value units [RVUs]) and the code that is bundled. CMS assigns 2.17 facility RVUs to 30903.

Therefore, you would submit the day's claim as 99251-99255 (Initial inpatient consultation for a new or established patient ...) appended with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), 30903, 30901- 59.
 
For the diagnosis, use the appropriate neonatal hemorrhage code, such as 772.8 (Other specified hemorrhage of fetus or newborn).