Oncology & Hematology Coding Alert

Question: Different insurance companies tell me different things about where to place modifier 59. Should I append it to the primary procedure or the secondary one? Pennsylvania Subscriber Answer: If you have instructions in writing from the payer, experts advise you to follow those instructions. However, in the absence of instructions to the contrary, you would append modifier 59 (Distinct procedural service) to the column 2 code of the Correct Coding Initiative (CCI) edit pair. Rationale: Medicare has at least two instructions regarding modifier 59 placement: 1. On CMS's CCI edits Web page (www.cms.hhs.gov/NationalCorrectCodInitEd/), there's a link to FAQs at the bottom. The FAQ with ID 3517 instructs providers to append modifier 59 to the column 2 code. 2. Medicare Claims Processing Manual, Chapter23, Section 20.9.1.1.B, says to append modifier 59 to the "secondary, additional, or lesser procedure(s) or service(s)." Some experts advise always appending modifier 59 to the [...]