Part B Insider - 2014 Issue 7
Modifier 59: Follow 5 Rules When You Use Modifier 59
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Article Overview
This article explains the general scope of modifier 59 use in emergency department coding and billing. It focuses on the types of situations the article addresses, including distinct procedural circumstances, relationship to bundled services and NCCI edits, and timing-based scenarios involving diagnostic and therapeutic procedures. The piece is intended for coders and billers who need to understand when the article’s guidance is relevant to physician and facility claims review.
Why This Topic Matters
Modifier 59 is frequently scrutinized in audits, so understanding the article’s scope can help coding professionals identify whether the full discussion applies to their documentation and claim review needs.
Article Sections
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Context and overview
Introduces the article’s focus on modifier 59 in emergency department settings and the broader coding context in which it is discussed.
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Remember These Two Overarching Rules For Modifier 59
Summarizes the general framing the article uses for modifier 59 and its relationship to other coding concepts.
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1. Different anatomic sites during the same encounter
Covers one major scenario discussed in the article involving separate locations and distinct procedural circumstances within a single encounter.
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2. Different encounters on the same day
Covers another scenario addressed in the article involving services performed at different times during the same calendar day.
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3. Do not rely only on different code descriptors
Discusses the article’s treatment of code-pair edits and why the article distinguishes descriptor differences from other circumstances.
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4. Diagnostic procedure before a therapeutic procedure
Addresses the article’s discussion of diagnostic testing that occurs before a later therapeutic service.
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5. Diagnostic procedure after a therapeutic procedure
Addresses the article’s discussion of diagnostic testing performed after a completed procedure and the timing considerations described.
What You Will Learn
- How the article frames modifier 59 in emergency department coding.
- What general categories of scenarios the article says are relevant to modifier 59.
- How the article discusses the relationship between modifier 59 and bundled services or edit concepts.
- What types of timing-based situations the article addresses for diagnostic and therapeutic procedures.
- What broad documentation themes the article emphasizes for distinct procedural reporting.
Who Should Read This
- Emergency department coders
- Physician coders
- Medical billing staff
- Coding auditors
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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