tci General Surgery Coding Alert - 2005 Issue 2

Red Flag Alert! CMS Puts the Squeeze on Modifier -59 Claims

Don't unbundle without rock-solid documentation If you're indiscriminately using modifier -59, you may get your claims paid - but you could be asking for trouble with potential audits and big penalties. To avoid running afoul of CMS regulators, always be sure the surgeon's operative notes make clear the distinct and separate nature of the procedure to which you are attaching modifier -59 Don't Treat -59 as a Catch-All You should never use modifier -59 (Distinct procedural service) if another modifier (or no modifier at all) will tell the story more accurately. CPT guidelines clearly indicate "that the...

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