BC Advantage - 2007 Issue 9

Taking the fear out of modifier 59

Modifier 59 was established to demonstrate that multiple yet distinct services were provided to a patient on the same date of service by the same provider.  Because distinct procedures or services rendered on the same day by the same physician cannot be easily identified and therefore properly adjudicated by simply listing the CPT procedure codes, modifier 59 assists the third-party payer or Medicare carrier in applying the appropriate reimbursement.  If the modifier is not used in these circumstances, a denial of services may result with an explanation of benefits stating, for instance for Medicare claims, "Medicare does...

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