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Thread: Use Of Modifier -59

  1. #1
    Join Date
    Apr 2007

    Default Use Of Modifier -59

    AAPC: Back to School
    Could someone go over w/ me when and how to use Modifier -59?


  2. #2
    Join Date
    Apr 2007


    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!
    Susie Corrado, CPC
    ENT Coding/Billing

  3. #3
    Join Date
    Apr 2007
    Bettendorf, Iowa


    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.

  4. #4
    Join Date
    Apr 2007
    North Carolina


    This link provides some good details


  5. #5
    Join Date
    Apr 2007
    St. Louis, Missouri


    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.

    Melissa Blow, CPC

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