Wiki Use Of Modifier -59

Create Wiki
Modifier -59 means distinct procedural service. You are trying to let the insurance company know that the procedures that you did were in different areas and needed to billed together when normally they would not. An example is when a GI doc does a colonoscopy and removes 2 polyps in 2 different areas. One is removed by snare and the other by hot biopsy. I would code 45385 (snare) and 45384/59 (hot bx). Without the 59 modifier 45384 would be bundled into 45385. Hope this helps!
 
We use a 59 in cases where our physicians perform an aspiration and bone biopsy. If they are done in 2 different sites on the body we attach a 59. If they are done at the same site they are bundled.
 
You would use modifier 59 if you did 2 procedures together that are normally not done together and if the 2nd procedure was a separate organ/separate incision/separate lesion...etc. You would put the 59 on the procedure the has the lower reimbursement because you will not get full payment for it.
 
You must log in or register to reply here.
Top