tci Part B Insider - 2008 Issue 29

Modifier Decision Tree: Go With the Flow to Make Your Modifier 59 Decisions Easier

This handy chart can help you decide whether modifier 59 applies to your claimYour physician performs two separate procedures that are bundled together under the Correct Coding Initiative (CCI) edits. The bundle has a status of "1," so you can break the bundle with a modifier. You append modifier 59 (Distinct procedural service) to the bundled code, because that's the only one you can use -- right?Actually, no, and this common pitfall sidetracks even the sharpest of coders. Don't rely exclusively on "the modifier of last resort" (modifier 59). This handy flowchart will help you determine your...

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