tci ED Coding & Reimbursement Alert - 2014 Issue 7

Modifier 59: Follow 5 Rules When You Use Modifier 59

Read on for a recap of the rules with ED examples for using to avoid future audit trouble. Reporting modifier 59 (Distinct Procedural Service) accurately in the ED requires that you understand the exact circumstances when it's appropriate to indicate your physician provided a service that was distinct or independent from other non-E/M services performed on the same day and which are not normally reported together. This can be hard to get right, but the adhering to five key rules can keep you in the winners' circle for your modifier 59 claims. Context: Modifier 59 (Distinct Procedural Service), which...

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