Neurology & Pain Management Coding Alert

Your modifier 59 claims will pass muster thanks to this quick refresher. When it comes to modifier 59, youre stuck between a rock and a hard place: Its essential for reimbursement when medical necessity and the documentation support its use, but Medicare, the HHS Office of Inspector General (OIG), and other payers scrutinize its use. Try these four expert methods to use your modifier 59 when you should. 1. Append 59 to the Secondary Code, Not Primary Use modifier 59 (Distinct procedural service) to identify procedures distinctly separate from any other procedure your neurologist provides on the same date. CPT and Correct Coding Initiative (CCI) Chapter 1 guidelines indicate that you may append modifier 59 to your claim when your neurologist: " Sees a patient during a different session " Treats a different site or organ system " Makes a separate incision/excision " Tends to a different lesion " Treats [...]