ED Coding and Reimbursement Alert

Modifier is not needed when the doctor treats different sites When you file claims with modifier -59 (Distinct procedural service), experts recommend keeping these facts in mind:

1. Multiple closures on different body sites or of different types (that is, simple, intermediate, or complex) aren't ever bundled together, so leave modifier -59 off of claims for multiple closures on different sites.

2. If you're not sure whether you can unbundle codes with modifier -59, be sure to check the National Correct Coding Initiative (NCCI) edits. If the codes you are reporting have indicators of "1" next to them, this means you can append the modifier to bypass the edit. If the code has an indicator of "0," you cannot bypass the edit. The NCCI edits change quarterly, so be sure to keep abreast of all updates.