Practice Management Alert

Knowing what's acceptable will save you headaches and lost revenue

CMS published an MLN Matters article (SE0715) giving you a host of examples that show when you can use modifier 59 (Distinct procedural service).

Example: You should bill bone marrow biopsy CPT 38221 and bone marrow aspiration code 38220 using modifier 59 only if you have two separate injection sites. Billers often inappropriately bill these two codes together with modifier 59 when a physician does them through the same injection site, and the OIG has identified this as an abused code pair.

Warning: You should only use modifier 59 to report nail debridement code 11720 and lesion paring/cutting codes 11055-11057 if the nails were on a separate anatomical area than the lesions or in a different visit, the MLN Matters article says.

Similarly, you can use modifier 59 for nail trimming code 11719 and nail debridement code 11720 only if the procedures affect different nails or happen in different encounters, CMS says. The same goes for lesion destruction code 17000 and lesion biopsy code 11100.

Take a look: You can read the entire article at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0715.pdf.