tci ED Coding & Reimbursement Alert - 2020 Issue Q4

Reader Questions: Clarify When Modifier 59 Applies

Question: We used to report modifier 59 (Distinct procedural service) frequently, but our administrator said we should use it sparingly, as it’s the “modifier of last resort.” Now we don’t use it at all, but I think we should be. When is this modifier warranted in the ED? Texas Subscriber Answer: You’re correct that modifier 59 should only be used when no other modifier is appropriate, but you’re also correct that there are some instances when it’s the only modifier that will describe your situation, and in those cases, it must be...

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