Health Information Management

Bill 94760-59, 82803 for ED visit

APCs Insider, December 9, 2005

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Bill 94760-59, 82803 for ED visit

QUESTION: If a physician orders a noninvasive ear pulse oximetry procedure (94760) during an emergency department (ED) visit -- and later in the same encounter the physician performs a blood gases test (82803) -- should we append modifier -59 to the ear pulse oximetry 94760 code? Our reasoning for appending modifier -59 is that the lab test was ordered after the initial evaluation, but during the ED visit.

ANSWER: It is appropriate to bill both 94760 with modifier -59 and 82803. Technically, there is a CCI edit for these two codes; however the OCE appears to allow both codes because 94760 is considered a procedure and 82803 is classified as clinical laboratory. This scenario also meets the definition of "separate and distinct" as required by modifier -59.

Use this modifier to identify procedures/services that are not normally reported together, but may be performed under certain circumstances. This modifier indicates that a procedure or service was distinct and independent from other services performed on the same day.

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