tci General Surgery Coding Alert - 2002 Issue 12

Use It, Dont Abuse It: How to Append Modifier -59

Modifier -59 (Distinct procedural service) is a powerful tool to increase payments, but improper use can lead to denied claims, audits or fraud allegations. This modifier allows surgeons to receive separate reimbursement for procedures that the Correct Coding Initiative (CCI) usually bundles if provided on the same date of service but in a particular instance were distinct or independent of one another. When Is -59 Appropriate? According to CPT, "Modifier -59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances." In essence, modifier -59 tells the insurer, "Although these services/procedures...

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