tci Part B Insider - 2019 Issue 2

Compliance: Consider This Expert Advice for Modifier 59 Mastery

Ensure your documentation supports modifier 59 usage. Before you append modifier 59 (Distinct procedural service), a comprehensive understanding of how and when to use the modifier is critical to avoid denials or worse. It’s a good idea to review coding guidelines and Medicare’s rules, too, before using this popular modifier. Remember: CMS reminds providers that there must be valid reasons to report a claim with modifier 59. “Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries)...

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