Super Posted Tue 14th of December, 2010 22:37:49 PM
We are getting frequent denials for reimbursement of CPT 94760 billed with a -59 modifier. The denial explanation states that this service is being bundled with the E&M. Is this correct?
SuperCoder Answered Wed 15th of December, 2010 06:29:35 AM
Modifier 59 is for distinct procedural service.
This modifier is allowable for radiology services. It may also be used with surgical or medical codes in appropriate circumstances.
To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.
94760 is bundled into any E&M service performed on that same day according to Medicare guidelines. Most carriers follow that policy.
If the service is done as part of an E&M visit then it would not be appropriate to unbundle them. If done at separate documented patient encounters, it would be appropriate to bill with a modifier 59. This highly monitored modifier should only be used if the documentation specifically states that separate sessions did occur and the rationale for the situation.
SuperCoder Answered Wed 15th of December, 2010 10:36:38 AM
Codes 94760 and 94761 are bundled by the Correct Coding Initiative (CCI) with critical care services. Therefore, codes 94760 and 94761 cannot be paid separately when billed with critical care (codes 99291 and 99292).
Amanda Answered Wed 15th of December, 2010 19:35:37 PM
I knew that we couldn't bill 94760 with a critical care code and we have been adding a -59 modifier when billing this with say 99213 but it still denies for bundling. I skimmed through the medicare guidelines and found that we couldn't bill this during surgical procedures because it stands to reason that the oxygen would have to be monitored. I also found that we couldn't bill when done in conjunction with devices used to promote better circulation which also seems justifiable to me.
SuperCoder Answered Thu 16th of December, 2010 06:19:11 AM