DecisionHealth, DecisionHealth - 2026 Issue 4 (April)

Ask probing questions to avoid misusing modifier 59

Modifier 59 (Distinct procedural service) has been associated with considerable abuse and high levels of manual audit activity, leading to reviews, appeals and even civil fraud and abuse cases. Given the scrutiny of the modifier, it’s vital that coders understand when it’s appropriate to add it to a claim.

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