Debra Posted Tue 28th of February, 2012 15:12:10 PM
An office visit was billed with an EKG and a foot xray for a patient and the EKG was denied by Medicare stating not covered when performed during the same session as a previous service so my biller added modifer -59, is this correct? Is Medicare saying that the EKG is bundled into the Xray or OV? This confuses me so any clarity is appreciated. Thank you in advance.
SuperCoder Answered Tue 28th of February, 2012 16:57:38 PM
The Medicare Claims Processing Manual instructs contractors to pay for only one interpretation of an xray
or ECG procedure furnished to a patient. Contractors pay for a second interpretation only under unusual circumstances. Without a modifier, and appropriate documentation, the second interpretation will be denied as duplicate by the contractor.Generally, contractors must pay for only one interpretation of an ECG or x-ray procedure.They pay for a second interpretation by a different physician (which may be identified through the use of modifier “-77”) only under unusual circumstances (for which documentation is provided) such as a questionable finding for which the physician performing the initial interpretation believes another physician’s expertise is needed or a changed diagnosis resulting from a second interpretation of the results of the procedure. See the following descriptions of the correct use of Second
Modifiers 76 and 77
Correct use of
modifier 76 and 77 will help to eliminate some of these denials and unnecessary appeals.
Modifier 76 - Repeat procedure by the same physician (ex: ECG or x-ray)
Is used by the same physician to indicate a procedure or service was repeated subsequent to the original
procedure or service.
Modifier 77 - Repeat procedure by a different physician. – Is used by another physician to indicate a
procedure or service was repeated subsequent to the original procedure or service.
It is important to use these modifiers in conjunction with additional documentation, such as the
time of day in Item 19 of the CMS-1500 claim form or the Comment field of the electronic version.
SuperCoder Answered Wed 29th of February, 2012 09:43:32 AM
I think this encounter is for foot injury so to bill a EKG you must have medical necessisity. I will answer this if you provide the diagnosis also their is no need to append -59 modifier the only thing you have to map EKG with a supporting diagnosis. In addition to this Modifiers -76 and -77 are only used when same procedure is performed.