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tci General Surgery Coding Alert - 2008 Issue 1

Modifier 59 Made Easy: Look for Separate Location/Session

Be sure to check CCI for a -1- modifier indicator -- or face denials Watch out: Payers know that modifier 59 is ripe for abuse, and time and again it comes under increased scrutiny from Medicare, the HHS Office of Inspector General (OIG) and others. Here are four expert-approved ways to bulletproof your modifier 59 (Distinct procedural service) claims.1. Recognize When 59 Applies You may use modifier 59 to identify procedures that are distinctly separate from any other procedure the physician provides on the same date. Specifically, CPT -- backed by guidelines found in Chapter 1 of the...

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