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Modifier 59

  1. Default Modifier 59
    Medical Coding Books
    I work for a Gynecologist who routinely does hysterectomies for patients, while doing a suburethral sling at the same operative time. The procedure codes for these are 58541 and 57288. He feels like the procedures should warrant the use of Modifier -59, thus being reimbursed at a higher rate. So far, insurance has not paid accordingly.
    Has anyone ever encountered this circumstance before? Should we attempt to appeal the claims? I feel like the insurance companies are considering the use of -59 inappropriate, and instead are paying only for multiple procedures (full allowance for primary, and 50% for secondary.)
    Any advice is welcome.

  2. #2
    Kingsport, TN
    It appears that your main procedure code (58541) is a laparoscopic procedure and code 57288 is not for laparoscopic procedures and to try 51992. Hope this helps.

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