Pediatric Coding Alert

Append -59 for procedures not normally coded together When a patient reports for a nebulizer treatment and instructions on the same day, do you report only one code? If the pediatrician performs two surgeries on the same day, do you assume that the lesser procedure isn't reportable? If you answered "yes" to either of these questions, you may not be taking advantage of all situations in which you can use modifiers -59 and -51. Read on for more information on these modifiers, to help you report related codes on the same claim. Modifier -59 Works When Codes Are Close Pediatric coders use modifier -59 (Distinct procedural service) to identify procedures that are distinctly separate from any other procedure or service the physician provides on the same date. Typically, coders in pediatric practices append modifier -59 to procedure codes when the physician: sees a patient during a different session treats a different site or organ system treats a separate injury. A common modifier -59 scenario in pediatrics involves patients who receive nebulizer treatments and instructions on the same day, says Lee Ann Shumiloff, billing manager for the department of pediatrics at the West Virginia University School of Medicine in Morgantown. Example: A 5-year-old established patient newly diagnosed with asthma reports with still-worsening symptoms and needs to be checked for medication adjustments. The pediatrician performs a level-three evaluation and management (E/M) service, administers a nebulizer treatment, and then decides that home treatments are necessary for the patient. 

He instructs the patient and his parents about how to conduct home nebulizer treatments before sending the child home. The claim should read: CPT 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem-focused history; an expanded problemfocused examination; medical decision-making of low complexity). If your insurance company requires it, append modifier -25  (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99213 to show that it was a separate service. 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler, or intermittent positive pressure breathing [IPPB] device). 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) with modifier -59 attached. ICD-9 code 493.02 (Extrinsic asthma; with [acute] exacerbation) should cover the entire service, says Shumiloff, who also reminds coders that modifier -59 should always be attached to the code for the additional procedure performed. This reporting method "works well with some carriers, but not all of them, of course," [...]