Pulmonology Coding Alert

Make sure you adhere to the correct criteria or suffer being 'red flagged.'A modifier in the right place at the right time is likely to get you a prompt and fair reimbursement. You use one of the most important modifiers -- modifier 59 (Distinct procedural service) -- so often that you think you know everything there is to know about it. Review essential facts about modifier 59 and avoid hitting a blank wall before it's too late.Guideline 1: Know Modifier 59's Criteria When You See ItThe right combination of a pulmonologist's procedure and a modifier can make or break your claim. "Every modifier tells a story," says Susan Ward, CPC, CPC-H, CPC-I, CPCD,CEMC, CPRC, coding and billing manager in Phoenix. Through modifiers, payers know what transpired during a procedure without having to go read every operative report.Modifier 59 indicates that a significant, separately identifiable procedure has been performed on the same day [...]