Wiki ahhh modifier 25 & 59

[jsa1517]

we have now come up with yet another issue with modifier 25 & 59. we are internal medicine and commonly do PFT's Neb treatments, EKGs, vaccinations, etc... we are now billing told by one insurance to not use these modifiers, weird?

here is an example of a scenario:

99396 (physical w/ dx v70.0) we put the 25 mod on visit
93000 (EKG) we put the 59 mod on this EKG
82962 (blood sugar)
90715 (Tdap)
90471 (Tdap admin) we put the 59 mod on admin

what are your thoughts, how would you code this???? mind you we have been doing it like this for months and have been paid, now they are telling us something different, i am in Connecticut. let me know!!! sooner rather than later,

thanks all!

 

[jmcpolin]

are 93000 and 90471 not getting paid without the 59 modifier?

 

[jsa1517]

the 90471 paid, but the 99396 & the 93000 haven't & the insurance says it is because of the modifiers, they are the same ?!

 

[jmcpolin]

can you bill the 93000 without the modifier since you already have the 25 on the 99396?

 

[ollielooya]

in addition, is a modifier even needed on the 90471 for this particular claim? Also, not sure why a modifier 59 would be needed on the 93000, is the 70.0 used for this dx as well?
---Suzanne E. Byrum CPC

Noridian (Washington)