DO I NEED TO APPEND A 59 MODIFIER TO CPT CODE 36011, WHEN BILLING FOR
CRITICAL CARE 99291 ON THE SAME DAY?

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Request for Question Clarification by ephraim-ga on 16 Sep 2003 20:08 PDT

Perhaps it's just that I'm not familiar with this area of information,
but I have no idea what you're asking for, what you'd like as an
answer, or even what this is referring to.

Please clarify this.

/ephraim

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Clarification of Question by leadhorse-ga on 16 Sep 2003 20:49 PDT

This question pertains to medical billing for Drs. This one in
particular has to do with billing a critical care patient in the
hospital using cpt code 99291 and the placement of a venous catheter
code 36011 and whether or not I need a 59 modifier on the catheter
code to get reimbursed by Medicare insurance.

If the e&m code is a significantly identifiable one other than the major 
surgery done along with the e&m code, add 25 modifier to e&m code not
to the surgery code 36011 or if the surgery procedure 36011 is decided
during critical care then add 57 modifier to the e&m code again.

There are 2 options - either 25 modifier or 57 modifier depending on the 
scenario but not a 59 modifier.

Note: 59 modifier can not be used with the surgery code 36011 but can
append either of these, to e&m code only.