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Payments on Mod 59

  1. Default Payments on Mod 59
    Medical Coding Books
    I have a question about when you bill with Mod 59. My doctor is understanding that when you bill with a mod 59, that you will be paid at 100%of the contracted rate. for example, he is a oncolgy surgeon and does a lot of melanoma surgery. He will bill for one patient:
    The insurance is paying the first code correctly and then paying the rest at the multiple procedure rule. Is there any way around this?
    Please help so I can explain to my doctor.

  2. #2
    The payor will pay based on your contract with that carrier regardless of modifiers used.

  3. #3
    Milwaukee WI
    Default -59 modifier
    The -59 modifier will allow you to bill a code that might otherwise be bundled into another code. It does NOT give you 100% reimbursement.

    Bear in mind that total reimbursement includes pre- and post-operative care. You aren't going to see the patient for each procedure separately are you?
    So the multiple procedure "discount" would apply.

    Hope this helps you explain it to your doc.

    F Tessa Bartels, CPC

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