Wiki A little advice for a sticky situation.

[nikkisgranny]

I work in an office who are 59 modifier abusers. Every multiple procedure is always coded with a 59. I want to educated my office administrator on what the billing department is doing. How to put this delicately is the question.

I am a new coder and the only CPC certified of the whole office. I suggested my very first time coding surgeries that this was wrong. The response I got was "that is the way the prior office manager had it set up..and that is what gets paid..insurance companies would not know what to do with a 51 if they had ever seen one."

I was taught that difference between 51 and 59. Now, how to educate others on their correct uses. Any advice?

 

[thompsonsyl]

Hi,

How about looking for info on the OIG's website. I found a 27 page manual completely dedicated to the use and abuse of modifier 59. The link is below:

http://oig.hhs.gov/oei/reports/oei-03-02-00771.pdf

I've seen that many physicians/surgeons use the modifier 59 to circumvent CCI Edits thereby unbundling procedures normally considered components of each other. This is risky especially if the documentation doesn't support the billing submitted.

Good Luck!