tgravely
New
I'm looking for resources or guidance on the appropriate usage of modifier 59 on 93317. Our pediatric cardiologists place the TEE probe and perform a complete study prior to the procedure. They produce a report and code 93315. The probe is left in place throughout the procedure. After the completion of the procedure, additional images are obtained and interpreted and a second report is generated. This is a limited, or "follow-up" study to ensure appropriate results of the intervention. They code 93317/59 for the additional image interpretation.
Some payers are accepting the 93317/59 for the follow-up study and paying both procedures, however, many others are denying the 93317/59 inclusive to 93315, even after we submit notes with both interpretations. In my research, I found that modifier 59 is allowed on 93317, but I also found several anecdotal resources stating that the follow-up image interpretation is inclusive in this scenario and 93317 would only be separately billable if another provider placed the probe and coded 99316. I'm unable to locate any "official" guidance on when modifier 59 is appropriate. Our cardiologists argue that the second set of image interpretation is a uniquely identifiable service, however, the counter-argument is that the 93315 description does not include any limits on the length of time the probe is in place or the number of images obtained, so since it was just one probe placement, all images obtained in the same session are inclusive.
If someone could point me in the direction of a good resource one way or the other to share with our cardiologists I would definitely appreciate it. Thanks in advance
Some payers are accepting the 93317/59 for the follow-up study and paying both procedures, however, many others are denying the 93317/59 inclusive to 93315, even after we submit notes with both interpretations. In my research, I found that modifier 59 is allowed on 93317, but I also found several anecdotal resources stating that the follow-up image interpretation is inclusive in this scenario and 93317 would only be separately billable if another provider placed the probe and coded 99316. I'm unable to locate any "official" guidance on when modifier 59 is appropriate. Our cardiologists argue that the second set of image interpretation is a uniquely identifiable service, however, the counter-argument is that the 93315 description does not include any limits on the length of time the probe is in place or the number of images obtained, so since it was just one probe placement, all images obtained in the same session are inclusive.
If someone could point me in the direction of a good resource one way or the other to share with our cardiologists I would definitely appreciate it. Thanks in advance