Health Information Management

Q&A: Should we report modifier -59 with drug administration services?

APCs Insider, November 14, 2014

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Q: We consistently hit an edit asking for a modifier on our drug administration service codes when reported with CPR (CPT® code 92950) and emergency intubation (31500). Our business office is adding modifier -59 (distinct procedural service) to bypass the edit so the claim will go out. The billing office tells us that this is an internal warning edit to be sure that the service was provided. I’m not so sure about this. If we have to apply the modifier consistently, something seems wrong.
 
A: Anytime you need to report a modifier to bypass an edit based on code pairs reported together, you should take a moment to pause and consider. When we think about reporting codes, we need to look at it as painting a picture or telling the story to the payer regarding what transpired during the patient’s encounter.
 
When two codes hit an edit, something about that picture doesn’t seem quite right. The next step is to be sure that you have all the pieces to the picture:
  • Is there documentation to support the services reported?
  • Are the codes that were reported correct to describe the services?
  • Should the codes be reported together on the claim based on the documentation?
 
To answer this last question, you must see if the drug administration services are truly separate and distinct from the CPR service and the intubation procedure.
 
Drug administration services are an integral part of both procedures. During CPR, IV pushes and infusions are given as part of the resuscitation effort. Therefore, they are part of the procedure reported with code 92950. When providers administer drugs via IV push—frequently etomidate and succinylcholine—to sedate the patient and paralyze his or her muscles so the provider can perform the intubation without trauma, these IV pushes are part of the procedure of emergency intubation. In these instances, the drug administration service is not separately reportable, and a modifier is not appropriate.
 
The NCCI Manual states:
A number of diagnostic and therapeutic cardiovascular procedures (e.g., CPT codes 92950-92998, 93451-93533, 93600- 93640-93657) routinely utilize intravenous or intraarterial vascular access, routinely require electrocardiographic monitoring, and frequently require agents administered by infusion techniques. Since these services are components of the more comprehensive procedures, codes for routine vascular access, ECG monitoring, and injection/services are not separately reportable.
 
Reporting a modifier just to satisfy an edit is never good practice. You must always review the documentation to ensure that the separate services are warranted to be reported and reimbursed.
 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular