tci ED Coding & Reimbursement Alert - 2004 Issue 8

Reader Question: Walk Softly When Billing 2 Tests

Question: I've heard that in order to bill both an EKG and rhythm strip in the same visit, we need to append modifier -59 to the rhythm strip (first making sure they were done at separate times, so as not to unbundle the procedure). Is the need for the modifier payer-specific or is it true for insurers across the board? New Hampshire SubscriberAnswer: Whether you need to append modifier -59 (Distinct procedural service) depends on the individual carrier. But regardless of payer, your practice should be wary of purposely performing procedures "at separate times" for payment reasons. If the...

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