tci Part B Insider - 2004 Issue 37

Part B Coding Coach: Keep Auditors Out With This Modifier -59 Checklist

You can avoid overusing -59 by simply consulting the CCI If you treat modifier -59 as a license to unbundle, it's only a matter of time before the feds come knocking at your door.   According to CPT, you should apply modifier -59 (Distinct procedural service) if the two codes you wish to bill meet the following criteria:   the same physician does not ordinarily perform the procedures on the same day, but the services are necessary under the circumstances; and   the codes fit into any of five situations: different sessions or encounters, different sites or organ systems...

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