Pathology/Lab Coding Alert

Question: Do we have to provide documentation when our pathologist uses modifier 59 to bypass a correct coding initiative (CCI) edit?

Ohio Subscriber

Answer: Yes. Best practices have always required that your pathology report document why you-re billing for a distinct service -- whether it represents a separate session, distinct anatomic site, or separate lesion, for instance.

But a revised CPT 2008 description of modifier 59 (Distinct procedural service) makes the case even stronger. The new wording states that when you use modifier 59, "Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury."

Beware: Presumably the change reflects the need to tighten up on documentation due to past problems with modifier 59 abuse.

-- Reader Questions were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.