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Modifying the modifier

April 1, 2015

In addition to the creation of several new CPT codes for 2015, one CPT change is not about a new code but rather an old modifier. Modifier –59 is used when we want to communicate with the insurance companies that we have a distinct procedural service, independent from other services performed on the same day. For instance if a child came into the office with a cough and, upon further examination, you discovered a bead in their nose — which you removed — you would want to be paid for the work you did.

The 9921x code would cover the evaluation of the cough and 69200 for the procedure of removing the bead. To be paid for both services, physicians have always placed the –59 modifier on the 69200. Technically, the –25 modifier should be placed on the 9921X but many insurance companies want it done with the –59 on the procedure.

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