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Modifier 59 Use

  1. #1
    Default Modifier 59 Use
    Medical Coding Books
    A pt has a chemo infusion from 9am to 10am. Following the chemo the pt
    has a hydration infusion from 10am to 11am. Would the hydration infusion
    have a modifier 59 attached to it. Thank you for your help

  2. #2
    96361 is not bundled with 96413 so modifier 59 should not be required. If the hydration was infused on the same DOS as the chemo infusion via a different site or during a different encounter (same DOS) and the hydration was reported as an initial service, 96360, modifier 59 would be required.

  3. #3
    Nashville AAPC Chapter
    I would normally agree with the Mod-59 not being required for the 96361 with the 96413, but I have had a few payor's that bundle any hydration at the same "event" and require a mod-59. So it can be payor driven at times.

    Have your payor provide a policy that states those requirements though.

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