Health Information Management

Pay-per-view: Decision tree helps guide appropriate use of modifier -59

APCs Insider, July 15, 2011

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Dr. Cooper attempts to repair a rotator cuff tear using an arthroscopic approach, but she is unable to complete the repair. She then converts the procedure to an open repair. Should the coder report both procedures and append modifier -59 (distinct procedural service) to the CPT code for the arthroscopic repair?

According to the NCCI edits, if an arthroscopic procedure fails and the physician converts it to an open procedure, coders may only report the open procedure, says Susan E. Garrison, CHCA, CHC, CCS-P, CPC, CPC-H, PCS, FCS, CPAR, executive vice president of Healthcare Consulting Services at Magnus Confidential in Atlanta.

Continue reading “Decision tree helps guide appropriate use of modifier -59” on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the July issue.



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