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Topic: Know the criteria for applying modifier -59 to podiatry codes

Ambulatory Surgery Reimbursement Update, September 16, 2008

Michael Warshaw, DPM, CPC, FACFAOM, healthcare consultant and practicing podiatrist in Ravenna, OH says to ensure that you append modifier -59 appropriately, remember that it:

·         Should appear only on a procedure code.

·         Indicates that a procedure code is a distinct or separate service from other services performed on the same day.

·         Is an anatomical modifier. Use it when there is no other anatomical modifier available to show that the procedure in question was a separate service from other services performed on the same day.

·         Is a multiple procedure modifier, so a physician must perform at least two procedures on the patient on the same day to use it. Never append modifier -59 to the first procedure.

In addition to knowing how to append modifiers, it is imperative for podiatrists to know the correct coding edits for every procedure that a physician performs, Warshaw says.

The National Correct Coding Initiative edits are Medicare’s method of bundling procedures. If a physician performs a procedure on a patient’s toe or foot, and the physician wants to perform another procedure at the same surgical setting and anatomical site on the same date of service, these coding guidelines indicate whether you can bill for that second procedure, says Warshaw.

“Unbundling is the most common coding mistake when it comes to coding for podiatry,” he says. “You have to know what is included in the procedure.”

Editor’s note: This topic is from the September 2008 issue of Ambulatory Surgery Coding and Reimbursement Insider.

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