Simplify the decision to use modifier -59

August 1, 2012
Briefings on APCs

A surgeon performs a diagnostic shoulder arthroscopy before repairing a patient’s rotator cuff. The surgeon knew ahead of time that he or she would be repairing the rotator cuff. Should a coder or biller append modifier -59 (distinct procedural service) to the CPT® code for the diagnostic shoulder arthroscopy to ensure reimbursement for both procedures?

Differentiate between types of coding edits

August 1, 2012
Briefings on APCs

Coders can run into two types of edits that may ­require them to append modifier -59 (distinct procedural service) to override: NCCI edits and medically unlikely edits (MUE).

Factor in appropriate resources for ED E/M criteria

August 1, 2012
Briefings on APCs

Coding for physician services doesn’t always match coding for facility services, which can cause problems for coders who code records for both. ED E/M is one area where different rules come into play.

Device-to-procedure edit reinstated, new codes added

August 1, 2012
Briefings on APCs

HCPCS code C1882 (cardioverter-defibrillator, other than single or dual chamber [implantable]) will once again meet the criteria to override the device-to-procedure edit for CPT® code 33249 (insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead[s], single or dual chamber).

This Month's Coding Q&A

August 1, 2012
Briefings on APCs

In this month's issue, our coding experts answer questions about how to differentiate between modifiers -52, -73, -74, coding for negative pressure wound therapy, and billing the technical component of pathology services.