Health Information Management

Tip of the week: Use modifier -59 when using multiple sites for separately identifiable services

APCs Insider, July 4, 2008

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When administering a chemotherapeutic agent in which protocol requires the use of two separate IV sites (e.g., whether port/peripheral, peripheral/peripheral, or peripheral/PICC), use an initial code that best describes the primary reason for the encounter. Always report that code regardless of the sequence of the infusions.

CMS Transmittal 968, dated May 29, 2006,states:

When administering multiple infusions, injections or combinations, the physician should report only one ?initial? service code unless protocol requires that two separate IV sites must be used.

The initial code is the code that best describes the key or primary reason for the encounter and should always be reported irrespective of the order in which the infusions or injections occur. If an injection or infusion is of a subsequent or concurrent nature, even if it is the first such service within that group of services, then a subsequent or concurrent code should be reported.

For example, the first IV push given subsequent to an initial one-hour infusion is reported using a subsequent IV push code.

If more than one ?initial? service code is billed per day, the carrier shall deny the second initial service code unless the patient has to come back for a separately identifiable service on the same day or has two IV lines per protocol. For these separately identifiable services, instruct the physician to report with modifier -59.

Therefore, you should report modifier -59 on the second initial code and second additional hour code to signify that this is a separately identifiable service.

Use CPT code 96413 (up to one hour of chemotherapy administration, IV infusion technique, single or initial substance/drug) for chemotherapy infusion through the Mediport, and add on code +96415 for each additional hour.

For chemotherapy administered through the peripheral site, use CPT code 96413-59 up to one hour and 96415-59 for each additional hour. Click here for more information.

(This tip was borrowed from the July issue of APC Answer Letter. To view the entire article, click here.)



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