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Outpatient Facility Coding Alert

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

- Published on Tue, Oct 17, 2017
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 [...]

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