Modifier 59 no longer an option for repeat services

If you’re starting to see denials when you append modifier 59 (distinct procedural service) to your claims that involve repeating the same procedure on the same date of service for the same patient, blame a change in Medicare claims policy that took effect on July 1, 2013.

Medicare Administrative Contractors (MACs) are restricting use of modifier 59 only to instances where your intent is to unbundle a National Correct Coding Initiative (NCCI) edit. This has been reported by Noridian, Cahaba and CGS Administrators, among other MACs.

When a procedure is repeated for other reasons, such as it for laterality or because it is being performed on different fingers or toes during the same date of service, use modifier 76 instead (repeat procedure). You would use this modifier on every service with the same code except the first one.

Continue to report other modifiers as appropriate, such as finger modifiers F1-FA, toe modifiers T1-TA, bilateral modifier 50, left side modifier LT or right side modifier RT.

MACs are instructed to deny use of modifier 59 with these claims as part of an effort to crack down on duplicate billing of services. Modifier 59 is for use only when no other modifier describes the service.