Forum - Questions & Answers

Dec 29th, 2011 - acarol8

modifiers

I noticed on the last request I sent, that nmaguire responded to, that modifier 59 was entered before the 26, on the last radiology code submitted on the claim, 75716, 59 26. I thought the modifier that affected payment was supposed to be placed first. Am I correct in this or has something changed, or have I always been wrong??
The reason I ask is, we have been billing our stents with heart caths as we have always billed them, a 26 59 on the cath after the stent. We have received rejections and were asked by the company that sends our claims, why we were not billing the 59 first?
Is this possibly the problem?
Please let me know

Dec 29th, 2011 - nmaguire   2,606 

re: modifiers

And I have always billed using 59-26 on cath when stent also inserted. No problem with payment thus far. The 59 modifier does affect payment by saying don't bundle, it's a separate diagnostic procedure

Dec 29th, 2011 -

re: modifiers

I know, but I thought the 26 should have been first because it told the payors this is a service that is a professional service. I am going to bill the 59 first from now on and save me a lot of headaches and rebills.
Thank you so very much for your help and input, and thank you for responding so quickly.



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