Wiki Modifier-59 - Can anyone clarify whether

[deivanaiv]

Hi,

Can anyone clarify whether we can append 59 modifier if services are provided by two different providers at two different session.

Eg:

Eg: Provider A performs 71020 at 10.00 am and provider B performs 71010 at 11.00 am.

(If it is done by same provider, we append 59 modifier to 71010. what is the rule if done by different providers for the same patient at different session)

Thanks,
Deivanai.

 

[Astoria70]

You wouldn't have to append any modifier to these if they are done on different days. If they are done on seperate days you should just bill the x-ray with the respective physician. When you put a 59 on these it indicates to unbundle the x-ray from the E&M. When physician does an x-ray no modifier needs to be put on the claim.

 

[deivanaiv]

Hi Niemia,

Thanks for your reply. I have asked whether we can append modifier 59 if two procedures ie 71020 done by one provider at 10.00am and 71010 is done by another provider at 11.00 am on the same day. Because when we look at the CCI, modifier 59 is allowed for 71010 when done along with 71020 on the same day.Hence I have doubt whether we should append this modifier only if same person repeats the exam or it be can different person?

 

[asaithambi]

Modifier 59

Hi

You will append modifier 59 to 71010 if different physician done in same day,Because CCI Edits apply to all physicians who bill for services on the medicare claims processing form typically used by radiology offices as well as to outpatient hospital claims as part of the Ambulatory payment Classification system (Please see the attachment). Hope this will HELP.



Thanks,

Asaithambi Dhanapal CPC View attachment CCI Edits.zip