tci Outpatient Facility Coding Alert - 2014 Issue 11

Modifier Refresher: Use Modifier 59 to Indicate That the Two Procedures Are Separate and Distinct

Remember to support your claim with medical records. Modifier 59 (Distinct procedural service) indicates that two services which are generally not reported separately are appropriately submitted this way because of the circumstances. Because of the unexpected filing together, it is very important that you have well documented medical records to substantiate your usage of modifier 59. Here are two examples of code pairs, which usually cannot be billed together by a provider for the same patient on the same date of service, but can be billed together by appending modifier 59 to bypass the code edit.  Key point:...

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