Under certain circumstances, a physician may need to indicate that a procedure or service was distinct or independent from other services. Modifier “-59” may be appropriate, depending on the circumstances and documentation. Modifier 59 is used to identify procedures/services that are not normally reported together. This includes the following, which are not ordinarily performed on the same day by the same physician:
A different
1. Session or patient encounter
2. Procedure or surgery
3. Site or organ system, or
A separate
1. Incision/excision
2. Lesion, or
3. Injury (or area of injury in extensive injuries)
When another established modifier is appropriate, it should be used instead of Modifier 59. Modifier 59 is a National Correct Coding Initiative (NCCI) associated modifier that is often used incorrectly.
NCCI indicates that Modifier 59 can be used to indicate that two or more procedures are performed at different anatomic sites, or during different patient encounters. It should only be used if there is not another modifier that appropriately describes the relationships of the two or more procedure codes.
Example of Modifier 59:
1. CPT code 11719 - Trimming of nondystropic nails, any number & CPT code 11720 - Debridement of nail(s) by any method one to five
Modifier 59 is appropriate if the trimming and the debridement of the nails are performed on different nails or if the two procedures are performed at separate patient encounters.
Remember, although you can bypass many of the bundles by using Modifier 59, this is the modifier of last resort.
If you need any additional information on this article, a Modifier 59 flow sheet, or Coding & Compliance services please contact Cindy Tipton at Cindy_Tipton@MED3000.com
For a printable version, click: CCNewsletterJune2008
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