Wiki Mod. 59 HWagner

[Ethanzoe]

The hospital I am a biller at has an associated ambulatory surgical center. I am doing the billing for the hospialists that work in the hospital itself. Sometimes we have conflict when a hospitalist does an inpatient history and physical for medicare patient and the physician from the surgical center gets called in for a consult on the same day of service. Medicare does not accept consult codes so when the consult code gets changed to a initial inpatient E/M we both have the same code on the same date of service. Is it appropriate to use Mod. 59 on one service or another so both get paid? That would mean two different physicians on the same date of service. We can't use a Mod. 25. Any advice would be greatly appreciated.

 

[mitchellde]

You cannot use a 59 on an E&M code . the physician that admits the patient needs to use an AI modifier and the consulting physician bills an initial level with no modifier.

 

[Ethanzoe]

Thank you. You are absolutely right on the 59 Mod. I was grasping at straws too quickly. Will the AI for admitting physician be enough to differentiate between the two for payment? I may use this forum more often unfortunately our hospital does not have an outpatient coder on staff. I am studying now to take the CPC so I appreciate the advice greatly! I have been thrown into editing the hospitalists billing summaries and I am nervous and love it at the same time.

 

[mitchellde]

Yes it is suppose to work that way... Heavy on the suppose to ! But as long as the AI is on thw admitting provider level you should be good to go.

 

[SCanterbury]

Medicare has no problem paying multiple physicians to see patients on the same day in the inpatient setting, as long as they are EACH attending to a SEPARATE aspect of the patient's care and not providing duplicative services due to some internal logistical confusion/facility mixup that caused the patient to be seen by both providers.

Seth Canterbury, CPC, CPC-I, ACS-E/M