Health Information Management

Q/A: Appropriate reporting of modifier -59 with EKGs

APCs Insider, April 2, 2010

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Q: I have a question pertaining to APCs Weekly Monitor’s advice published March 12, “Using modifier -59 for EKG.” Your advice indicates that we need to consider information beyond whether the EKG was performed prior to or following the procedure. An EKG performed during the procedure generally is integral to the procedure and not separately coded. Your advice appears to address medical necessity. Reporting a code for a procedure is appropriate to identify procedures that aren’t a comprehensive component of the global surgical package to provide accurate data if for no other reason.

Previous APCs Weekly Monitor advice published November 14, 2008, indicates that appending modifier -59 when reporting an EKG performed pre- or post-heart catheterization is appropriate in accordance with the National Correct Coding Initiative Coding Policy Manual for Medicare Services. Please clarify.
A: There is no “blanket answer” concerning the application of modifiers to any procedure code. Documentation in the medical record alone determines whether a modifier is appropriate. Because that information is not available, the APCs Weekly Monitor panel can’t provide a definitive yes or no answer, unless a modifier is never allowed.
The NCCI edits and manual allow use of modifiers with code pairs, but CMS cautions providers to review the service before appending a modifier to ensure that it is separate and distinct. Global surgical packages are not applicable to hospital/facility providers, only to physician services. CMS has provided guidance in the OPPS final rules and several transmittals regarding how to report resources expended for services not separately reported.
The November 14, 2008, APCs Weekly Monitor directed readers to NCCI manual language concerning whether adding a modifier to EKG pre- or post-catheterization is permissible. The NCCI manual states a modifier “may” be added. APCs Weekly Monitor’s answer did not imply that a modifier always would be added in this circumstance.

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