tci Outpatient Facility Coding Alert - 2013 Issue 11

Reader Question: Check Latest Instructions Before Reporting Modifier 59

Question: We were just notified that modifier 59 is no longer accepted by Medicare payers. Can you tell us what we should use instead? Kentucky Subscriber Answer: You can still use modifier 59 (Distinct procedural service) when you need to demonstrate that two separate and distinct procedures were performed during the same session. What you can’t do, however, is use this modifier for repeat procedures or other instances when a different modifier would be more appropriate. Many Part B MACs posted instructions about modifier 59 on their websites this summer, which may have created the confusion. Cahaba GBA...

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