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Pediatric Coding Alert

You Be the Coder:

Is Modifier 59 Required?

Question: I read that Medicaid will pay for 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler, or IPPB device) when billed with other nebulizer services if modifier 59 (Distinct procedural service) is attached, so I've been putting it on all my 94664 charges and it has worked. I am also appending modifier 59 to all of my 69210 (Removal impacted cerumen [separate procedure], 1 or both ears) charges when we bill it with an E/M service. However, I don't want to signal any red flags to an insurer by overusing modifier 59, so can you tell me if I'm using it correctly? Rhode Island Subscriber Answer: The answer regarding the 94664 issue depends on which other services you're providing during the same visit. For instance, if you report it with 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction...), most insurers would [...]