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tci Outpatient Facility Coding Alert - 2015 Issue 11

Modifier Review: Know Your Modifier 59 Better for Cleaner Claims

Modifier 59 (Distinct procedural service) is used when two codes are not normally reported together (for instance, one code may be bundled with the other), but may be billed together under certain circumstances (for instance, if the two procedures occurred at different anatomic locations during the same patient encounter). Modifier 59 is the “modifier of last resort” because you should append it only when no other modifier is more appropriate (e.g., modifiers to describe laterality, such as LT, RT, and 50), and documentation supports a distinct or independent service. Therefore, check before appending modifier 59, beginning with...

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