Modifier 59 Spotlight

In today’s spotlight series episode, the focus is on the trickiest modifier of them all: Modifier 59.

Terry dedicates an entire episode to this modifier, which also includes the X-modifiers or the subset modifiers that have been effective since 1/7/2015.

The most common reason the 59 modifier should be used is to indicate that two or more procedures were performed at the same visit but to different sites on the body. Unfortunately, it is one of the most misused modifiers. Many times it is used to prevent a service from being bundled, or added in with another service, on the same claim.

It should never be used strictly to prevent a service from being bundled or to bypass the insurance carrier’s edit system.

Terry will clarify its use as well as discuss the Subset X-Modifiers for compliant coding and maximized reimbursement.

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