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Medical documentation should always be submitted with the use of what modifier?

Medical documentation should always be submitted with the use of what modifier?

Describe a scenario that would require the use of that modifier.

Include a description of the medical documentation that would be submitted with the modifier.

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Modifier 59 It is used to identify procedures/services that are commonly bundled together but... View the full answer

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  • When using the 59 modifier to indicate a distinct and separate service, documentation should be in the patient’s medical file that substantiates that the services were performed separately. The insurance carrier may request to review the record to deem if the 59 modifier is being appropriately used before reimbursing the full amount for the modified CPT code. It’s important to note that use of the 59 modifier does not require that there be a different or separate diagnosis code for each of the services billed. As such, simply using different diagnosis codes for each of the services performed does not support the use of the 59 modifier. 59 Modifier Examples An example of appropriate use of the 59 modifier might be if a physical therapist performed both 97140 (manual therapy) and 97530 (therapeutic activity) in the same visit. Normally these procedures are considered inclusive. If the 59 modifier is appended to either code, they will both be allowed on the claim separately. However, the 59 modifier should only be added if the two procedures are performed in distinctly separate 15 minute intervals. If the therapist performs the procedures simultaneously, then the 59 modifier should not be used. Another example would be if the patient were having a nerve conduction study with CPT codes 95900 and 95903 being billed. If the two procedures are done on separate nerves, then the 59 modifier should be used to indicate that. If the codes were performed on the same nerve, then the 59 modifier should not be used. The biller should never be the one to add the 59 modifier to a claim, even if she knows that billing the services without the modifier will result in bundling or a denial. The 59 modifier should only be added by the provider or by a coder who has access to the patient’s chart.
    • queen25
    • Jul 21, 2016 at 6:02am

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