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

0 Votes - Sign in to vote or reply.
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 .

0 Votes - Sign in to vote or reply.
Sep 28th, 2011 - rphelps 615  1 

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

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

0 Votes - Sign in to vote or reply.
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.

0 Votes - Sign in to vote or reply.
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?

0 Votes - Sign in to vote or reply.


Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association