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Thread: Help with Modifier 59

  1. #1

    Talking Help with Modifier 59

    AAPC: Back to School
    I am new to the Coding/Billing world. I need some clarification on Modifier 59. When billing for the E/M code if additional work is done at the same time would you add modifier 59 or 51 to additional procedures done the same day at the same time?

    Also on same day surgeries/procedures that are in the same incision but different areas, would you append 59 or 51???

    Please Help!!

  2. #2

    Smile 59 Modifier and 51 Modifier

    59 Modifier = Distinct Procedural Service. Be careful with this code. It is not appended to a E/M code. This is to identify a distinct procedure done on the same day as another procedure. Modifier 59 was established to demonstrate that multiple, yet distince, services were provided to a patient on the same date of service by the same provider. Example may be but not limited to: Closed reduction of right radious and ulna, on the same day as a closed reduction of a tibia/fibula fracture on the same day and encounter.

    If a E/M was done on the same day as a procedure, and the procedure was seperate from the E/M code, you would attach a 25 modifier to the E/M code. This is not to be used for a dicision to preform surgery. This is to be used for a minor procedure on the same day, and the procedure, must be seperate than the E/M service. This does not include a pre- or post op visit either. One example may be that the patient was coming in for the evaluation of diabetes glucose and medication check, then it was discovered that a foot ulcer needed to debrided in the office. The E/M code with a 25 modifier could be billed and the debridement would be Seperate.

    51 modifier is for Multiple procedures other than E/M services are done on the same day, by the same physician. The primary procedure is listed first, then the following with a 51 modifier. Be sure to not attach a modifier to a "Modifier 51 Exempt" code. Do not reduce your fees for these services, as the insurance company will cut them anyway.

    I would have to know more details in your example to help you further. Hope this is a help

  3. #3


    Ok so let me give you an example. During surgery the doc went in through an incision to fix a tendon and while there he also had excise a malignant tumor. Which modifier would you use on the second procedure?

    You just hear alot of DONT use modifier 59, so I want to be sure that its being used correctly.

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