Part B Insider (Multispecialty) Coding Alert
-59 Modifier Under Scrutiny, Expert Warns
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The -59 modifier may get your claims paid, but you could be storing up a world of hurt for later if you overuse it.
"It's overused just to get through the edits," consultant Annette Grady with Eide Bailly in Bismarck, ND says of the -59 modifier. It's often hard to figure out when to use -59appropriately, but it's vital to do so.
The Centers for Medicare & Medicaid Services is currently looking closely at -59, Grady believes. While each carrier and payor has different claims review software, it's a safe assumption that many carriers will single out claims with the -59 modifier for extra scrutiny. The North Dakota Medicaid program actually handles all claims with the -59 modifier by hand, Grady adds. "It automatically pops them out," and reviewers go over the claims for medical necessity.
Part B carrier Noridian subjects claims with the -59 modifier to a post-payment or prepayment audit, Grady insists.
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