Physician Practice

Q&A: Why do we hit an edit when adding potassium to a metabolic panel?

Physician Practice Insider, March 10, 2015

Q: I have a question regarding a National Correct Coding Initiative (NCCI) edit. I reported CPT® code 80053 (comprehensive metabolic panel) and 84132 (potassium; serum, plasma or whole blood) resulting in an NCCI conflict. This code pair does allow modifier -59 (distinct procedural service) to be appended to one of the codes to be paid for both tests. Does it matter if we append modifier -59 to the primary code or the secondary?

In my case, sometimes the secondary code is already dropped into the system and now the edit is asking me to append the modifier. Can I add modifier -59 to code 80053 whether it's the primary code or not?

A:
In my opinion, the conflict is not about the modifier, it is about duplicate reporting.

Code 80053 already specifically includes 84132. If you report 84132 separately in addition to 80053, you are reporting the potassium test twice. The potassium test is already being reported and reimbursed for as part of in the reimbursement for 80053.

In response to your second question, modifier -59 would be appended to a secondary code, not the principal procedure code. If the physician orders a medically necessary repeat potassium test or documents medical necessity for repeating another part of the panel, modifier -59 could be appended to the second code. However, the documentation would have to justify the test as medically necessary and show that it was performed.

Editor’s note: Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, of Safian Communications Services in Orlando, Florida, originally answered question in JustCoding.com.
 

Most Popular