Health Information Management

Q/A: Using modifier -59 with EKGs and cardiac catheterization

APCs Insider, April 29, 2011

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Q. We have an ongoing debate about modifier -59 (distinct procedural service). Some physicians order an EKG (also known as an ECG) the morning of a cardiac catheterization procedure to obtain a baseline reading before the procedure and some order an EKG approximately one hour after the procedure to be certain the patient is not experiencing a rhythm change. The cardiology department charges for the EKG, but claim generates an edit that requests modifier -59. We frequently assign modifier -59 to bypass this edit. Is doing so appropriate?

A. This topic has caught the attention of recovery audit contractors (RAC) and now appears on the approval list for some RAC regions. The National Correct Coding Initiative Policy Manual for Medicare Services states in chapter 11:

A cardiac catheterization procedure or a percutaneous coronary artery interventional procedure may require ECG tracings to assess chest pain during the procedure. These ECG tracings are not separately reportable. Diagnostic ECGs performed prior to or after the procedure may be separately reportable with modifier -59.

If documentation substantiates that an EKG was performed as a diagnostic test (signs/symptoms or other indications) either before or after a cardiac catheterization procedure, append modifier -59. However, an EKG performed as a baseline screening or to be certain that everything is okay after a procedure, is not a diagnostic test and should not be reported with the modifier. Review documentation carefully because each scenario is unique and consider all factors including physician orders.

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, president of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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