Urology Coding Alert

Watch out: If you override every ‘1' bundle, you're asking for trouble.

During the same operative session, your urologist performs two separate procedures that the Correct Coding Initiative ( CCI Edits ) bundles with a status indicator of "1," so you can automatically break the bundle using modifier 59 (Distinct procedural service) -- correct?

Think again. Even veteran coders can fall into the modifier 59 trap. You should not automatically append modifier 59 just because CCI puts a modifier indicator of "1" on a bundle, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians (UWP) Compliance Program. Modifier 59 is actually the "modifier of last resort," Bucknam explains.

Here's why: Incorrectly unbundling without proper documentation can result in payback requests and accusations of fraud.

This handy flowchart will help you determine your modifier options and select the right modifiers when you're faced with coding two procedures during the same operative session.