Wiki 99144-59

[JDACPC]

Medicare patient had conscious sedation on two completely separate encounters on same DOS. The second encounter was denied with the 59 modifier attached. Any way to get this paid? This seems to me the perfect 59 scenario and this is a valid modifier (perhaps not for Highmark but no policy to verify). I wouldn't think combining the total minutes would apply but I don't see any other way.

Any help would be appreciated.

Thanks!

 

[dwaldman]

They might looking at it like if there is a code pair, modifier 59 would be appropriate on the column two code if it was performed on a separate site or separate encounter. But without a bundling issue with a column one code, the separate encounter would not meet a situation where it is needed to apply the 59 modifier to alert them to bypass the edit. I agree that combine the times would be the best way to capture this date of service you are working on.