CODING & DOCUMENTATION

Answers to Your Questions

  • Modifiers -51 & -59
  • Infirmary consultation codes
  • Anaphylactic shock
  • Description

Modifiers -51 & -59

Q

What is the applied difference between modifiers -51, "Multiple Procedures," and -59, "Distinct Procedural Service?"

A

Modifier -51 indicates that you lot did more than one procedure at the same session. For case, if y'all excise a benign skin lesion with an excised diameter over four.0 cm from a patient's chest and close the defect using a layered closure, you would submit code 11406 ("Excision, beneficial lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter over four.0 cm") and 12032–51 ("Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding easily and feet]; 2.6 cm to seven.5 cm"). Since payers, such as Medicare, typically reduce the fee for the code with modifier -51 attached by about 50 per centum, you should adhere it to the lesser-valued service so that you are paid in full for the more than expensive procedure. All the same, be sure to bill the full fee for each procedure and let the payer make the reduction consistent with its ain payment policy.

Modifier -59 indicates that 2 services non unremarkably reported separately are accordingly reported separately under the circumstances. For example, if you see an accident victim in the emergency room and the patient requires fracture care on the right arm and some strapping on the left arm, you may demand to adhere modifier -59 to the strapping code to indicate that it was separate from and should not exist arranged with the fracture care, which includes the initial cast, strap or splint. Modifier -59 should be attached to the bottom valued of the ii services or to the lawmaking, regardless of value, that would otherwise exist denied or is a component of some other, more comprehensive code. This modifier is usually considered a last resort, since its descriptor says that it should only be used "if no more than descriptive modifier is available, and the utilise of modifier -59 best explains the circumstances."

Occasionally, yous tin utilize both modifiers at the same fourth dimension. Using the earlier example, if you perform a pare biopsy of another lesion on the patient'due south chest during the same visit, you would submit 11100 ("Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed [divide procedure]; single lesion") in addition to the other codes and suspend modifier -51 and modifier -59 to information technology. Modifier -51 would be attached considering the biopsy is the lesser-valued process washed at the same session, and modifier -59 would be attached to indicate that the biopsy, which is normally arranged with excision of the same lesion, was done on a separate lesion from the i that was excised.

Hospital consultation codes

Q

I was told that I shouldn't be using consultation codes when asked to consult on established patients in the hospital. Is this correct?

A

It depends on the situation. For instance, if a surgeon admits one of your established patients for hip surgery and, subsequent to the surgery, asks you for your opinion and advice regarding evaluation and/or direction of the hypertension the patient is having in the hospital, y'all may code that service as a consultation, provided that you document the request and any services ordered or performed and that y'all communicate a written report to the surgeon. For this consultation, you would submit an initial inpatient consultation lawmaking (99251–99255). Follow-upwardly inpatient consultation codes (99261–99263) could be submitted for whatsoever subsequent consultations performed during the patient's inpatient stay nether any of the following circumstances:

  • When you need an additional visit to complete the initial consultation;

  • When the attending physician requests additional evaluation of the same problem;

  • When the attending physician requests evaluation of a new problem (there tin but be one initial in patient consultation per patient past the same md per hospitalization).

Consultation codes may also be appropriate for some postoperative evaluations. The Medicare Carriers Transmission states that "a doctor who performs a postoperative evaluation of a new or established patient at the request of the surgeon may bill the advisable consultation code for [East/M] services furnished during the postoperative flow following surgery equally long equally all of the criteria for the use of the consultation codes are met and that same doc has not already performed a pre-operative consultation" (emphasis added). Thus, when consultations are performed on Medicare patients in the infirmary before and later surgery, the pre-operative consultation can be coded as described above and the postoperative consultation can be coded with the appropriate subsequent hospital intendance code (99231–99233). Subsequent hospital care codes should too exist used instead of consultation codes if another physician asks y'all to manage part of a patient's inpatient care rather than simply to provide your advice or if you lot assume responsibility for management of all or role of a patient's inpatient care afterward you lot render your consultation.

Anaphylactic shock

Q

What diagnosis lawmaking should I submit for anaphylactic daze due to practice?

A

Try submitting 995.0, "Other anaphylactic stupor," which includes anaphylaxis not otherwise specified.

Clarification

In the July/August issue, "CPT lawmaking for semen assay" [page 26] indicated that CPT code 89321 should be used for semen analysis post-vasectomy. This is true every bit long equally the vasectomy and semen analysis were not performed by the same entity (e.g., if a family practice office lab does a semen analysis for a patient who received a vasectomy from a urologist across town). When the two services are performed by the aforementioned entity, the more appropriate code to apply is 55250, "Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)."

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Kent Moore is the AAFP'south manager for wellness intendance financing and delivery systems and is a contributing editor to Family unit Practice Management. These questions and answers were reviewed past members of the FPM Coding & Documentation Review Panel, which includes: Robert H. Bosl, Md, FAAFP; Marie Felger, CPC; Thomas A. Felger, Medico, DABFP, CMCM; David Filipi, Physician, MBA, and the Coding and Compliance Department of Physicians Clinic; Lynn Handy, CPC, LPN; Emily Colina, PA-C; Joy Newby, LPN, CPC; P. Lynn Sallings, CPC; and Susan Welsh, CPC.

Conflicts of involvement: none reported.

Editor's note: While this department attempts to provide authentic data and useful advice, 3rd-party payers may not accept the coding and documentation recommended. Yous should refer to the electric current CPT and ICD-nine manuals and the Documentation Guidelines for Evaluation and Management Services for the most detailed and up-to-date information.

Nosotros WANT TO HEAR FROM YOU

Send questions and comments to fpmedit@aafp.org, or add your comments below. While this department attempts to provide accurate information, some payers may not take the communication given. Refer to the current CPT and ICD-x coding manuals and payer policies.

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