Help with modifier

Please help resolve this problem in our office. When billing an ER physician exam with an EKG, is it appropriate to use a 59 modifier? Example...99284-25, 93010-59. I do not believe this is correct. But, someone has decided that going forward, we need to bill all BCBS claims this way. They usually bundle it with the exam as most other insurance companies do. A link to a site confirming this so I can provide proof would be very helpful. Thank you!

re: Help with modifier

I don't have a link, but hop on over to your CPT® book, in the back is a full description of the modifier 59 that clearly states it is to be used to distinguish one procedure from another "NON E/M SERVICE" performed on the same day.

The 25 should be the only modifier you need, but unfortunately BCBS is known for requiring add'l documentation when a 25 is used.

re: Help with modifier

Modifier -59 cannot be placed on E/M code or radiation oncology codes

re: Help with modifier

There are so many private payers now that are using a claims editing program (probably owned by a company that sells software and products to us....) that requires modifier 25 on an E/M when an injection, lab test, immunization, x-ray: anything is done on the same day. Sometimes, it isn't required from a coding perspective but is from a reimbursement perspective. There is no reason I know of to require a 25 modifier on the same day as EKG reading. But, you have to add it for some insurers. Then, we start adding it on all of the claims for all insurers, "just to be sure." And who can blame us?

I can't see why modifier 59 is required.

re: Help with modifier

We always use a '25' on the E/M code if other procedures follow it. I just don't think it's appropriate to use '59' on the EKG. I worry it may cause both lines to deny.

re: Help with modifier

I do not recommend billing an office and EKG with modifier 59. We've always used modifier 25 on the office visit with NO modifier on the EKG.