tci Part B Insider - 2009 Issue 29

PART B MYTHBUSTER: Look at All Other Options Before Using Modifier 59

Remember that modifier 59 can't solve all your unbundling woes. Myth: Modifier 59 is an easy way to collect when you bill bundled procedures together, and allows you to gain extra reimbursement for your claims any time the Correct Coding Initiative (CCI) bundles procedures together. Reality: In many cases, other modifiers represent your services more appropriately than modifier 59 (Distinct procedural service) -- and in other instances, no modifier will apply to your claim, and you'll instead have to accept the fact that two procedures might be bundled. To avoid running afoul of CMS regulators, always be sure the...

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