Business

You could be loosing money by not using Modifiers correctly.

Using Modifier 59


CPT Manual defines modifier 59 as a “Distinct Procedural Service“. The 59 modifier is considered the most misused modifier by coders. It is normally used to indicate that two or more procedures were performed during the same visit to different sites on the body.

Unfortunately, it is too often applied to prevent a service from being bundled or conjoined with another service on the same claim. It should never be used strictly to prevent a service from being bundled or to bypass the insurance carrier’s edit system.

59 should also only be used if there is no other, more appropriate modifier to describe the relationship between two procedure codes. If there is another modifier that more accurately describes the services being billed, it should be used in place of the 59 modifier.

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