BC Advantage - 2017 Issue 11


Modifier -59 is used to define a "Distinct Procedural Service" to indicate that a reported code represents a service that is separate and distinct from another service with which it would usually be bundled. The -59 modifier is the most widely used HCPCS modifier and is associated with considerable abuse and high levels of manual audit activity, leading to reviews, appeals, and civil fraud and abuse cases.The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as to identify different encounters, different anatomic sites, and distinct...

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