g.fairchild
Networker
Morning All..
I had a rather interesting discussion with not one, but two CSR's at Palmetto GBA, Ohio Part B Carrier. One of my staff was advised to append modifier 59 to one of our Fluoroscopy codes (77003) as it was bundled into the procedure performed. Of course she obliged...and rebilled the claim with the 59 modifier. I explained to her that she cannot do this because the Fluoro is required to perform the procedure, and it is not separate. She then told me she was advised this way by Medicare.
Okay...so I called them myself and spoke with TWO different CSR's (Crystal & Katoya)there who told me I COULD append the 59 modifier to the Fluoro because it was a separate procedure...??????...hmmmm....this is not how I understood the -59 modifier. I also directed THEM to THEIR Modifier 59 article and gave reference to "Surgery: Example 6"... and read them both, verbatim: "Cpt modifier 59 is only appropriate if the ultrasonic guidance is performed for a procedure that is UNRELATED to the surgical laparoscopic ablation procedure..." STILL, after reading this to them, I was told that I could append the -59 modifier because (again) it was a separate procedure!! OMG....so wonder Medicare is so messed up, and now I am confused as I though I understood it.
Any thoughts out there on this one??? Thanks for setting my mind straight, as I think I have lost it....
I had a rather interesting discussion with not one, but two CSR's at Palmetto GBA, Ohio Part B Carrier. One of my staff was advised to append modifier 59 to one of our Fluoroscopy codes (77003) as it was bundled into the procedure performed. Of course she obliged...and rebilled the claim with the 59 modifier. I explained to her that she cannot do this because the Fluoro is required to perform the procedure, and it is not separate. She then told me she was advised this way by Medicare.
Okay...so I called them myself and spoke with TWO different CSR's (Crystal & Katoya)there who told me I COULD append the 59 modifier to the Fluoro because it was a separate procedure...??????...hmmmm....this is not how I understood the -59 modifier. I also directed THEM to THEIR Modifier 59 article and gave reference to "Surgery: Example 6"... and read them both, verbatim: "Cpt modifier 59 is only appropriate if the ultrasonic guidance is performed for a procedure that is UNRELATED to the surgical laparoscopic ablation procedure..." STILL, after reading this to them, I was told that I could append the -59 modifier because (again) it was a separate procedure!! OMG....so wonder Medicare is so messed up, and now I am confused as I though I understood it.
Any thoughts out there on this one??? Thanks for setting my mind straight, as I think I have lost it....