Orthopedic Coding Alert

Although you shouldn’t be afraid to use modifier 59 when the medical necessity and documentation support it, you should never report modifier 59 carelessly or merely to get claims paid.

You may use modifier 59 to identify procedures that are distinctly separate from any other procedure your orthopedist provides on the same date.

According to CPT® instructions and Chapter 1 of the national Correct Coding Initiative, you may append modifier 59 when the physician:

• treats a patient during a different session
• treats a different site or organ system
• makes a separate incision/excision
• treats a different lesion
• treats a separate injury.