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billing with modifier 59

Aida Posted Thu 14th of March, 2013 15:38:09 PM

i just started working at a neurlogy office. Still learning their billing cpt codes. I noticed they use many modifiers.

I am appealing a claim that was denied,they billed cpt codes 95921-59, 95922-59, and 93040-59 this procedures were done on the same day of service.

My question is can cpt codes 95921 and 95922 be billed without the modifier 59.

I believe they can. Please can someone help me.

Aida Posted Thu 14th of March, 2013 15:55:01 PM

Additional to my previous question, what modifier would i use to bill 93040 when billing 95921 and 95922 on the same date of service.

SuperCoder Answered Fri 15th of March, 2013 21:58:18 PM

Yes, you should be able to report autonomic testing codes 95921 (Testing of autonomic nervous system function; cardiovagal innervation [parasympathetic function], including two or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio), 95922 (... vasomotor adrenergic innervation [sympathetic adrenergic function], including beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver and at least five minutes of passive tilt) and 95923 (... sudomotor, including one or more of the following: quantitative sudomotor axon reflex test [QSART], silastic sweat imprint, thermoregulatory sweat test, and changes in sympathetic skin potential) separately on the same date of service.

Prior to Nov. 1, 2001, the National Correct Coding Initiative did bundle 95921, 95922 and 95923. Since then, however, CMS has acknowledged that 95921, 95922 and 95923 describe different services and that there are circumstances in which the neurologist may have a medically necessary reason to report two or more autonomic testing codes on the same day. If your payer bundles these codes, you should appeal the decision.

But several payers - including some Medicare carriers - consider these tests to be investigational and may not reimburse for 95921, 95922 and 95923. Ask your individual payer for its policy.

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Code 93040 is a column 2 code for 95921 , but a modifier is allowed in order to differentiate between the services provided.
*Use modifier 59 with code 93040

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