I work for an Urgent Care, and I'm a little confused about modifier -59. When we do a laceration repair, say 12001, we almost always do a tetanus vaccination. I'm being told that I need to bill my E/M code with -25, then 12001, then 90471-59, and 90715. Is that correct? I'm also being told that -59 is required if there are any two non-lab procedure codes used with the E/M. For example, a laceration repair and a breathing treatment. Can someone clear this up for me? Thank you.
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Wiki Modifier 59 help-work for an Urgent
- Thread starter bforr
- Start date
mitchellde
True Blue
you only need the 59 modifier when you need to indicate a second and subsequent procedure is distinct and separate procedure. If the description of the code alone shows the second procedure is distinct and separate, and there is no CCI edit, then you have no need for a modifier. A vaccine administration by description is distinctly different for a lac repair.