Wiki Modifier 59

cynacosta

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Hello,

Is there ever an appropriate time to apply modifier 59 to all the procedure codes billed out? The procedures were all done by the same physician during the same operation.
I was under the impression that the modifier 59 would only be applied to additional cpts and not the primary procedure.

Example:
44626,59
49560,59
45330,59


Thank you all for your help
 
It would be not appropriate - at least one code should not have a modifier. Modifier 59 (or any modifier, for that matter), must be supported by documentation. As per the CPT definition, modifier 59 "is used to identify procedures or services, other than E/M services, that are not normally reported together but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury...not ordinarily encountered or performed on the same day by the same individual." So that modifier should only be reported on the codes which are not normally reported separately from a more comprehensive and/or mutually exclusive procedure which would not have the modifier.

I've worked for a number of payers, so actually I have seen this a lot. Some providers seem to just put the modifier on every code because they don't want to take the time to research which codes need it and which don't, and think that this will just make sure that nothing is ever denied for bundling. Unfortunately, they may not realize that payers are aware of this and that overuse of the modifier makes them an easy target for auditors who are looking to find overpayments for recovery, or to identify potential fraud.
 
Thomas,

Thank you for your help! I had never seen anyone just put mod 59 on all the codes so I just wanted to make sure I was reading the definition correctly.

Thanks again for your response!
 
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