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).
A physician can debride a wound to remove dead, damaged, or infected tissue so the remaining healthy tissue can better heal. Coders need to look for specific information in the documentation of wound debridement.
Pain is an expected component of injuries, illnesses, and surgical procedures. Let's face it, breaking your leg hurts. In some instances, however, the patient's pain is unexpected or is worse than predicted. Sometimes, the pain can last well beyond the time it should have resolved.
Our coding experts answer your questions about correct use of modifier –PD, coding infusions to correct low potassium levels, payment for HCPCS code J2354, appropriate reporting of IV push followed by infusion of the same drug, and the difference between modifiers –AS and -80.
Our coding experts answer your questions about payment for items in OPPS Addendum B and skin substitutes, incomplete documentation for IV infusions, coding for amputation of finger and aftercare, facility codes for peritoneal dialysis
Facilities can't bill for skin substitutes unless they also bill for a skin substitute application procedure on the same date, according to the April update to the I/OCE. If facilities don't comply with this practice, they won't receive payment for the skin substitute. The April update includes a list of eight procedure codes (CPT codes 15271-15278) and 27 specific skin graft materials.
