dure you performed, but didn't change its definition or code. You use
modifiers to indicate that the procedure being billed has been modified
or altered from its published description, not to seek additional reim-
bursement.
Use modifier -59 for accurate and appropriate reimbursement when 2
services that normally would be bundled together are in a particular cir-
cumstance distinct and separate. For example, a biopsy and an excision
of the same lesion usually bundle so you're not reimbursed separately
for them. But if you perform an excision of a separate lesion, you'd
attach
-59 to the normally inclusive procedure code to indicate that the second
excision is distinct and separate.
You'll leave a lot of money on the table if you don't use -59 when
appropriate, or if you use it incorrectly. Take a colonoscopy, for exam-
ple. Let's say the physician removes multiple lesions or biopsies multi-
ple sites within the colon. He removes a polyp via snare in the
descending colon (45385 primary procedure) and performs a cold
biopsy in the transverse colon (45380-59). If you don't bill them sepa-
rately or bill them without a modifier -59, you're shortchanging your
center.
Failing to make adjustment/write-offs. Establish a cap/dollar
amount for when administrative approval is and isn't mandatory
before adjustment or write-off. It's common for facilities with higher-
than-normal days in accounts receivable to never make
adjustments/write-offs because:
• no policy and procedure is in place;
• no cap is given, which allows for automatic adjustments when
applicable and without approval, particularly when the account is paid
6
Coding & Billing
CB
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