Despite its apparently straightforward definition in the CPT® Manual, modifier -59 (distinct procedural service) can be deceptively difficult to append properly.
Our experts answer questions about NCCI edits for injections, modifier -25, modifier -59, laminotomy with insertion of Coflex distraction device, billing mammogram for needle placement, and auditing electronic orders.
Also known as the "mega rules," the omnibus final rules are clarifications and finalizations of the HIPAA rules of 2003, the HITECH rules of 2008, and the incorporation of the Genetic Information Nondiscrimination Act (GINA) rules into the Privacy and Security rules. These are not sweeping changes, as many describe, but clarifications. In most cases, what are now final rules are best practices that organizations should already be following.
Q. Is it a HIPAA violation if a hospital receives a faxed Healthcare Effectiveness Data and Information Set (HEDIS) request and the hospital cannot identify the patient by full name, last name, or date of birth? These requests contain name, date of birth, provider, and the HEDIS Measure (Chlamydia screening, cervical cancer screening, cholesterol management, etc.) and last date of service of the patient. Typically, these faxed requests are from business associates of the patient's health insurance, but occasionally they come directly from the insurance company.
