When is modifier 59 used

However, when another already established modifier is appropriate, it should be used rather than modifier Only if no more descriptive modifier is available, and the use of Modifier 59 best explains the circumstances, should Modifier 59 be used.

When you have distinct, separate procedures, know which modifiers will get the claim paid in full. Unfortunately, modifier 59 gets misused a lot. As a result, some payers now automatically deny CPT codes appended with modifier This forces the provider to appeal the denial and send in the documentation to show that modifier 59 was applied correctly. Modifier 59 different substance should be attached to the lesser valued technique indicating that separate agents were administered by different techniques.

CPT codes describing chemotherapy administration include codes for the administration of chemotherapeutic agents by multiple routes, the most common being the intravenous route. For a given agent, only one intravenous route push or infusion is appropriate at a given session.

It is recognized that frequently combination chemotherapy is provided by different routes at the same session. When this is the case, using the CPT codes , , and Modifier 59 should be attached to the initial incisional hernia repair code.

When a recurrent incisional or ventral hernia requires repair, the appropriate recurrent incisional or ventral hernia repair code is billed. A code for initial incisional hernia repair is not billed in addition to the recurrent incisional or ventral hernia repair unless a medically necessary initial incisional hernia repair is performed at a different site.

The X modifiers apply to Medicare Part B. Be sure to review the documentation and ask yourself if the unbundling is justified enough to apply the appropriate X[ESPU] modifier. It is often used when modifier 51 is the more accurate modifier. This quick reference sheet explains when, why and how to use it. However, when another already established modifier is appropriate it should be used rather than modifier Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

Become a member , or learn more about the benefits of membership by clicking on the link below. Are you a coder, biller, administrator, office manager or physician? Many times providers inappropriately use them, an abuse which inevitably leads to claim denials. For our guide on the 3 most commonly misused modifiers, click here.

However, when another already established modifier is appropriate, it should be used rather than modifier Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

When to Use the 59 Modifier The 59 modifier is one of the most misused modifiers. The most common reason it should be used is to indicate that two or more procedures were performed at the same visit but to different sites on the body. Unfortunately, many times it is used to prevent a service from being bundled or added in with another service on the same claim. If there is another modifier that more accurately describes the services being billed, it should be used instead of the 59 modifier.

The insurance carrier may request to review the record to deem if the 59 modifier is being appropriately used before reimbursing the full amount for the modified CPT code. As such, simply using different diagnosis codes for each of the services performed does not support the use of the 59 modifier. Normally these procedures are considered inclusive.

If the 59 modifier is appended to either code, they will both be allowed on the claim separately.