Ophthalmology and Optometry Coding Alert

Indicators, separate sites hold clues to proper use. When your ophthalmologist performs two medically necessary procedures during the same session, knowing the ins and outs of modifier 59 is essential for your accurate coding. The problem: Modifier 59 (Distinct procedural service) is one of the most misunderstood, overused, and abused modifiers. Avoid problems -- and get your claims paid compliantly -- by following these proven tips: Tip 1: Know When to Use Modifier 59 The Office of Inspector General (OIG) and many payers, including Medicare, continually review physicians' modifier 59 use. In fact, according to a 2005 review by the OIG and an independent contractor, 40 percent of code pairs studied did not meet program requirements for proper modifier 59 use. There are circumstances when you can -- and should  -- use modifier 59, however. For instance, you may use modifier 59 to identify procedures that are distinctly separate from another procedure provided by [...]