New modifier 59 guidance suggests crackdown, offers clues to beat it

Why This Topic Matters

Modifier 59 remains a frequent audit target, so updated CMS commentary can affect compliance risk, claim review priorities, and how practices evaluate their own reporting patterns.

Article Sections

1. CMS guidance and non-contiguous sites

   This section discusses updated CMS materials and the general issue of multi-site procedures, including how non-contiguous locations are being addressed in the context of modifier 59.

2. Examples involving podiatry and other procedures

   This section reviews specialty-specific examples used to illustrate the kinds of procedural combinations and anatomical scenarios being discussed in the guidance.

3. Scrutiny of 59 ramps up

   This section covers the broader compliance environment, including contractor attention, work plan focus, and the audit concerns associated with modifier usage.

4. Practical review considerations by specialty

   This section offers general commentary on reviewing modifier use within different specialties and the kinds of workflow or auditing resources that may affect compliance efforts.