Health Information Management

Tip of the week: Append modifier -59 correctly

APCs Insider, June 13, 2008

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There are many legitimate uses for modifier -59. But, with drug administration, as with other types of coding, the challenge is to use it only when necessary.

Use modifier -59 to report multiple encounters on the same date of service. Also use it when you report two initial drug administration service codes, to reflect two different vascular access sites (e.g., an infusion in the right arm and left arm).

"You can almost think of treating each access site as if it was an encounter in and of itself," says Valerie Rinkle, MPA, revenue cycle director for Asante Health System in Medford, OR. Report an initial code for each site, in addition to any necessary subsequent, sequential, or add-on codes.

"Then pick one [site] and report modifier -59 on the CPT code to clearly communicate to CMS that you are deliberately reporting two initial service codes to represent two different vascular access sites," she adds.

Also, use modifier -59 to override certain National Correct Coding Initiative (NCCI) edits that may appear. But be careful to do so appropriately. "Just because you get an edit doesn't mean that modifier -59 is the appropriate way to fix the line item in order to get it paid," Rinkle said.

Don't be surprised if you see more and more services triggering NCCI edits related to a drug administration services. You will need to go through your usual process of determining whether you can appropriately append modifier -59 to the line item in order to bypass the edit.

(The above tip was excerpted from a JustCoding.com article. To view the article, click here).



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