Forum - Questions & Answers

Sep 28th, 2011 - peds28490 5 

Modifer Help!!! Please!!!!

What modifer do I use when billing 94640 & 94060 on the same claim? Thank You! Lynn

Sep 28th, 2011 - jschmutz   323 

re: Modifer Help!!! Please!!!!

These two codes are bundled together and are not separately reportable unless separate and distinct procedures were performed .

Sep 28th, 2011 - rphelps 615  1 

re: Modifer Help!!! Please!!!!

If you bill them use a 59 modifier on one of them.

Sep 29th, 2011 - rorlando 1 

re: Modifer Help!!! Please!!!!

Try putting the 59 modifier on the 94640. Also, if an evaluation and management is done, you will need a 25 modifier on the visit, other wise you might not get paid for the visit.

Sep 29th, 2011 - jschmutz   323 

re: Modifer Help!!! Please!!!!

You can't just unbundle them by appending a 59 modifier without knowing whether it is appropriate to do so and it is irresponsible for someone to suggest a modifier without knowing if what your physician is doing is separate and distinct.

Yes, a 59 modifier will get them paid, but is it appropriate to do so in your case and are you fraudulently unbundling them?



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