E/M Coding Alert - 2020 Issue 11
Reader Questions: Clarify When Modifier 59 Applies
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Article Overview
This reader Q&A addresses the general circumstances in which modifier 59 may be warranted in emergency department coding and why it should be used only when no more specific modifier fits. It is aimed at coders and billing staff who need to understand how to recognize separate services, procedures performed in different anatomic contexts, and situations where another modifier may be the better choice.
Why This Topic Matters
Proper modifier selection affects claim accuracy and helps avoid inappropriate use of a broadly applied modifier. The article gives practical context for distinguishing when a distinct-service modifier may be needed and when a different modifier applies.
Article Sections
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Question
The reader asks about general circumstances in which a distinct-service modifier may be warranted in emergency department coding and how often it should be used.
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Answer
The response discusses broad situations where the modifier may be appropriate, including services involving different anatomic locations or separate noncontiguous injuries, and notes the need to consider more specific modifier options when available.
What You Will Learn
- The general purpose of modifier 59 in emergency department coding
- Broad situations in which a distinct-service modifier may be considered
- Why more specific modifiers should be evaluated before using a broadly applied modifier
- How a reader question can be interpreted in the context of separate procedures and repeat services
Who Should Read This
- Medical coders
- Billing staff
- Emergency department coding professionals
- Coding auditors
- Compliance staff
Codes Discussed
Modifiers Discussed
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