tci E/M Coding Alert - 2021 Issue Q3

Reader Questions: Avoid This Modifier for E/M Services

Question: We reported 99212 with an injection code, and appended modifier 59 to the claim, but the payer only provided reimbursement for the injection — not the E/M code. What went wrong? Utah Subscriber Answer: You should never use modifier 59 (Distinct procedural service) on an E/M service. Scenarios like this require the use of modifiers 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) or 57 (Decision for surgery), depending on encounter specifics. In general, modifier 25 should be...

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