Pulmonology Coding Alert

Append modifiers -59 and -51 in order to separate related codes When your pulmonologists perform multiple procedures in a single visit, you'll likely use either modifier -59 (Distinct procedural service) or modifier -51 (Multiple procedures) to prove that you aren't trying to double-dip on your claim. Modifier -59 Separates Related Procedures Modifier -59 identifies a procedure that is distinctly separate from any other procedure or service the pulmonologist provides on the same date.

You should apply modifier -59 if your services fit into any of five situations, according to CPT:

different sessions or encounters
different sites or organ systems
separate incisions/excisions
separate lesions
separate injuries (or areas of injury). Because these situations describe scenarios that may often arise in your practice, you might think that you will often append modifier -59 to separate services. However, many coders refer to -59 as the "modifier of last resort" and avoid using it unless they have to. Because of this difference of opinion, some practices aren't sure when they can and cannot report modifier -59.

"It's confusing because modifier -59 is the modifier of last resort, but it's also a National Correct Coding Initiative unbundler," says Jeff Fulkerson, BA, CPC, CMC, certified coder at Emory University in Atlanta. "If you're trying to separate services that NCCI normally bundles together, you should use a modifier to separate them, but it won't always be -59."

Use modifier -59 only when no other descriptive modifier fits the documentation, such as modifiers -25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service; -58, Staged or related procedure or service by the same physician during the postoperative period; or -76, Repeat procedure by same physician. "If, after considering the other options, -59 is still the most appropriate modifier, you should report it," Fulkerson says. Explanation: Generally, says Heather Corcoran, coding manager at CGH Billing Services in Louisville, Ky., you should use modifier -59 if the physician performed services at separate sessions or for different reasons on the same day.

Think of it this way: Modifier -59 tells the payer that the procedures were not components of one another but were actually both medically necessary and separate from one another, Corcoran says. Review Documentation to Ensure Smooth Pay Want to increase your chances of coding success with modifier -59? Talk to your doctors, because your modifier -59 claims will go through a lot easier with good operative notes. Pulmonology example: Mary Beth Wass, MC, CMM, manager at the Asthma and Allergy Center in Papillion, Neb., says that since code 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered [...]