tci General Surgery Coding Alert - 2019 Issue 4

Modifier Focus: Avoid 59 Fatigue With 3 Tips

Brush up on CMS guidance. Before you use modifier 59 (Distinct procedural service) again, read this. Misuse and overuse of this modifier could result in claims denials, sacrificed pay, penalties, or worse. Follow these expert tips to get the pay you deserve and avoid claims problems for your general surgery practice. Tip 1: Track CMS Guidelines You may use modifier 59 when you can document circumstances that result in the surgeon performing multiple procedures that don’t usually occur together. CMS puts it this way in the Medicare Claims Processing Manual Chapter 23, (updated in Transmittal 4188 dated December...

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