Coding specialists? Code stacking and modifier 59.

crystalp 7 years ago in Billing/Electronic Modules updated by Deb Fitz 7 years ago 6

Has anyone in this community taken a coding class or have coders/billers who are well educated in the area of code stacking/billing multiple codes for one DOS with same provider? We have providers who render in home services that last longer than 1 hour and are trying to teach them how to code stack and then trying to figure out the best way to bill them to get them paid. Any help is appreciated!

we use the modifier 59 when someone is seen for therapy the same day the are attending group

I'm revisiting this as we are providing more services where our clinicians are going to patients home and providing multiple services in one day, ie, 90846, 90847 and Ind session with client. Wondering if anyone has had luck getting paid for 3 services using appropriate modifiers? We are able to get paid by using modifier 59 for let's say family session and individual on same date. In case anyone is curious where the 59 modifier goes, here is my cheat sheet, information was found on NCCI site. I would love to know if anyone knows where to add the modifiers if billing 3 codes  like I mentioned before? 

  • 90791 (Diagnostic Evaluation) is a stand alone code that will NOT pay with others on the same DOS.

  • When 2 family sessions (with patient & without patient) are billed on same DOS, the family session without patient (90846) is primary, and the family session with patient (90847) needs modifier 59.

  • When 2 sessions are billed on the same DOS, one of them family session (90847) and the other an individual session (90832), the ind. session needs the modifier 59.

  • Group codes are considered primary, so the individual code need the 59 modifier.

  • Family 90846/90847 is primary when billed with individual, so the individual code needs the 59 modifier.

Add the 59 modifier in the data link right before creating the invoice.

If I'm understanding you correctly. when billing the 90834, 90846 & 90847 on the same day, Per NCCI edits both 90834 & 90847 are column 2 codes to 90846 and those would require the modifier appended to them. 

If you bill 90834, 90847 & 90853 on the same day, Per NCCI edits both 90834 & 90847 are column 2 codes to 90853 and would require the modifier 59 appended.

When billing MA, they have stopped paying for both 90837 and 90847/90846 on the same day even with the -59 modifier. Are there certain payers that you get paid using -59 modifier?

This is what I have found when billing MA. When using the code 90791 (no modifiers), MA will not pay for another therapy (unless its bundled with the H2012 for example H2014+90853) they consider the other therapies part of the DA. If you had 90853 and a 90847 both on the same day (no 90791) it will pay for both but you can only use the 59 modifier on one of them not both. When you use the 59 modifier basically you are saying that both of those therapies were done on the same day this is why you can only use it with 1 of those codes. This is what I have found when working in the MNITS site and researching the 59 modifier. I hope this helps

You will also need to be aware of which code needs to have the modifier appended- in the last scenario 90853 & 90847- per NCCI 90847 requires the modifier, you cannot just add it to either one.  This is a possibility as to why some may not getting reimbursed correctly with 2 services provided on the same day.