tci Medicare Compliance & Reimbursement - 2007 Issue 23

CODING: Are You Setting This 59-Modifier Audit Bait?

Quick test can say for sure.Myth: If you do two bundled procedures in the same session but for different reasons, you can always use the 59 modifier to unbundle them.Reality: You can use the 59 modifier only if the two procedures were in different sessions, were in different anatomical areas or were otherwise totally unrelated. The recent MLN Matters Article SE0715 contained a host of examples showing when you can use the 59 modifier. For example, you should bill bone marrow biopsy code 38221 and bone marrow aspiration code 38220 using the 59 modifier only if you...

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