Modifier 59 exceptions
Effective March 1, 2011, Modifier 59 will not override the following incidental edits/code combinations:
92502 when billed with 30000 - 31615 (nose, accessory sinuses, larynx, trachea)
92502 when billed with 40490 - 42972 (lips, vestibule of mouth, tongue and floor of mouth,dentoalveolar structures, palate and uvula, salivary gland and ducts, and pharynx, adenoids, and tonsils)
92502 when billed with 69000 - 69979 (auditory system)
45990 when billed with 45000 - 45999 (rectum) and 46000 - 46999 (anal)
57410 when billed with 56405 - 58999 (female genital system)
94150 - Vital capacity, total
94250 - Expired gas collection, quantitative, single procedure
94690 - Oxygen uptake, expired gas analysis; rest, indirect
94760 - Noninvasive ear or pulse oximetry for oxygen saturation; single determination
94761 - Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations
Modifier 81 – Minimum Assistant Surgeon
Effective March 1, 2011 When Modifier 81 is billed and the procedure is considered eligible for use of an assistant surgeon, Modifier 81 will be paid at 12 percent of the recognized charge/surgical fee allowance or the negotiated rate.
Reference: http://www.aetna.com/provider/data/OLU_SE_DEC2010_v4.pdf
Effective March 1, 2011, Modifier 59 will not override the following incidental edits/code combinations:
92502 when billed with 30000 - 31615 (nose, accessory sinuses, larynx, trachea)
92502 when billed with 40490 - 42972 (lips, vestibule of mouth, tongue and floor of mouth,dentoalveolar structures, palate and uvula, salivary gland and ducts, and pharynx, adenoids, and tonsils)
92502 when billed with 69000 - 69979 (auditory system)
45990 when billed with 45000 - 45999 (rectum) and 46000 - 46999 (anal)
57410 when billed with 56405 - 58999 (female genital system)
94150 - Vital capacity, total
94250 - Expired gas collection, quantitative, single procedure
94690 - Oxygen uptake, expired gas analysis; rest, indirect
94760 - Noninvasive ear or pulse oximetry for oxygen saturation; single determination
94761 - Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations
Modifier 81 – Minimum Assistant Surgeon
Effective March 1, 2011 When Modifier 81 is billed and the procedure is considered eligible for use of an assistant surgeon, Modifier 81 will be paid at 12 percent of the recognized charge/surgical fee allowance or the negotiated rate.
Reference: http://www.aetna.com/provider/data/OLU_SE_DEC2010_v4.pdf
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