Why use modifier 59

Modifier 59 is used on a second procedure to indicate that although there is a procedure-to-procedure bundling edit for the second code with the first service, the second procedure meets the criteria of a distinct procedural service.

For lesions, for example, this most often means the second procedure was done on a different lesion than the first. Never use both modifier 51 and 59 on a single procedure code. Login to view the rest of this article. Learn more about membership. Are you a coder, biller, administrator, office manager or physician? Learn more about the benefits of a CodingIntel membership. If you are the biller and you believe that the 59 modifier would be appropriate but was not indicated, you should go back to the provider to see if it was omitted by mistake.

Misusing 59, or any other modifier, can cause a payer to deny your claim altogether. Avoid claim issues by making sure to always use it properly. Have you ever experienced a denial due to misuse of modifier 59? How was it resolved? This mother-and-daughter team maintains two medical billing websites, a free newsletter and an active forum. Alice and Michele are on the editorial staff of BC Advantage and are regular contributors to the magazine.

Their books are available at www. Procedure Coding: When to Use the 59 Modifier. Learn about the pros and cons of in-house billing vs. Click here. Free e-book: Pros and Cons of In-house vs. Also from ACP, read new content every week from the most highly cited internal medicine journal. Visit Annals. Modifier 25 The first modifier to consider is Modifier 59 Modifier 59 identifies procedures or services that are not normally reported together.

In this way, modifier 59 is essentially a tool to bypass or override the NCCI edit. If the circumstance calls for a Level 3 established patient visit CPT code to be billed with a demonstration of home monitoring of a patient's international normalized ratio e. Disease Management. Practice Tips. Editor's Note.