tci General Surgery Coding Alert - 1999 Issue 3

Modifier 59: It's Not a Liscense to Unbunble, Could be a Red Flag for an Audit

The use of modifier -59 (distinct procedural service) can be a double-edged sword for general surgery practices.Typically, -59 is used to identify procedures performed on the same day that normally would not be reported together because they are bundled in a global package. Under certain circumstances, however, general surgeons may use modifier -59 to indicate that a procedure was distinct or independent from other services performed during the same 24-hour period.According to CPT 1999, This may represent a different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of...

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