We make it easy to find the online medical coding solution with just the features you need! |Learn More >>

Outpatient Facility Coding Alert

HOPD Compliance:
Don't Use Modifier 59 to Unbundle 93505 and 93454

CMS wants you to avoid the problems outlined in the OIG report. Does your hospital outpatient department submit claims for patient encounters that include both outpatient right heart catheterizations (RHCs) and heart biopsies? If so, CMS wants you to know that it's not okay to use modifier 59 (Distinct procedural service) to override NCCI edits that bundle the two procedures [...]