Healthcare News: 2016 NCCI Manual includes updated modifier -59 guidance

January 5th, 2016

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article reviews a 2016 update to CMS NCCI Manual guidance related to modifier -59. It focuses on broad areas such as timed services, same-encounter procedures, anatomic-site considerations, and how the update fits into Medicare coding guidance for providers and coders.

Why This Topic Matters

It helps coders, billers, and compliance staff understand that CMS revised parts of the NCCI Manual and added examples relevant to procedural reporting and edit bypass scenarios.

What You Will Learn

  • What areas of NCCI Manual guidance were updated by CMS
  • How the article frames modifier -59 in relation to timed services and procedure edits
  • What kinds of coding scenarios the update is intended to clarify
  • Which organizations and code sets are referenced in the update

Who Should Read This

  • Medical coders
  • Coding auditors
  • Billing staff
  • Compliance professionals
  • Physicians and therapy providers

Codes Discussed

  • CPT: 97112
  • CPT: 97110
  • CPT: 11055
  • CPT: 11720

Modifiers Discussed

  • CPT: -59

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