Modifer -59

[Linda]

Hello
Is there any time modifer -59 would be used after the second IM. I believe the coders used this code for maybe the second IM given at same encounter. With -25 appended to the E/M level. I could be wrong. Linda Stricklin.

 

[Alicia Scott]

I know that -59 can unbundle. Let me check into this for you. I don't want to give you the wrong answer. Laureen may know off the top of her head as she is a whiz at CPT. ICD is my thing We all have coding quirks. I just don't think I can answer with confidence off the top of my head. So, that being said I will do some checking for you. Great question. You can't be the only one who needs clarification. Thanks for posting.

 

[Laureen]

Of course each payor is different but here is my take on it. There is no "shared" component to the work of giving two shots so the 2nd shot fee should not be considered bundled into the other and therefore 59 would not be needed. You only need it if it would be common to bundle the two codes together.

The modifier 25 on the EM may be needed depending on the payer. Some payors bundle the shot admin code into the EM. So if you are reporting an EM code in addition make sure it is indeed "separate" and "significant" and if so by all means append the 25.

HTH

 

[Linda]

Thank you all for your time. Just makes me wonder what they had us doing at work. Can't wait for the webinar tonight. Got my twitter ready ))) Linda

 

[Ruth Sheets]

This was discussed in the October 2012 Q and A Webinar. If you missed it, it will be available for those belonging to the CCO Club.