I don't agree that the 59 modifier replaces the 51 modifier but a lot of insurance companies treat the 51 modifier as informational only. It used to be used to designate which procedures received the multiple procedure reduction but payers go by the Medicare Physician Fee Schedule now so don't rely on the physicians to provide that information any more.
The 59 modifier designates that a procedure is separate and independent from another procedure billed and relates to CCI edits. It should only be used if there is no other applicable or appropriate modifier that could be used instead.
Is it that insurances aren't allowing it anymore or is it just unnecessary? I don't know what it hurts to use it if they just aren't recognizing it. I also wouldn't just substitute the 59 across the board because that could raise some red flags (as well as possibly being inappropriate in a lot of cases). I'd check into it further.
- ICD-10 Training
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join