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Orthopedic Coding Alert

You Be the Coder:

Billing an E/M Service With FNA of Bone Lesion

Question: Our payer is denying a claim involving an E/M and a fine needle aspiration (FNA) of a bone lesion with modifier 59 for an improper modifier. Is my modifier use appropriate? California Subscriber Answer: Most payers, including Medicare carriers, require modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or [...]