Modifier 59 – Are You Using It Correctly?

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Modifier 59 - Are You Using It Correctly?
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Modifier 59 - Are You Using It Correctly?
Did you know one of the main reasons for claim
denials and revenue loss is the incorrect usage
of modifiers? Undoubtedly, medical bills are
being claimed in a combination of codes for the
services performed in the medical practice. But
that is not all required. The accurate coding of
such corresponding treatment modifiers is
mandatory to ensure the reimbursement of these
claims, including Modifier 59 (Distinct
Procedural Service). In fact, the claim form also
needs to have diagnosis codes along with proper
ICD 10 codes. If you are wondering why, you
should be concerned about whether you are using
Modifier 59 correctly, the reason is that it is
one of the most misused modifiers. Unfortunately,
you would not be alone and lose your revenue for
the failure to use Modifier 59 correctly. Read
more
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Modifier 59 - Are You Using It Correctly?
What Is Modifier 59 Used For? Typically, Modifier
59 indicates that more than one procedure is
performed on the patient in a single visit. But
such procedures should be on the different part
of the bodies. However, at times, it is used to
bypass the edit system of the insurance carrier
and avoid being bundled with another service on
the same claim. Going by the guidelines, it
should never prevent a service from getting
bundled with the other. Modifier 59 is developed
to indicate a physician's service on the patient
during the same visit whereby the procedures are
independent of each other. Such modifier helps in
reporting the services usually performed
together, but it can be done under certain
circumstances, as deemed fit by the physician.
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Modifier 59 - Are You Using It Correctly?
Are You Adding Modifier 59 Correctly? As a
claimant, you must be aware that Modifier 59 is
used correctly with other modifiers. For
instance, you cannot include Modifier 59 with
Modifier 76. Thereby, your claim will get
rejected altogether. The reason is that Modifier
76 is used for stating the same procedure being
performed on the patient multiple times on the
same day by the same physician after the initial
consultation. Whereas Modifier 59 indicates
different sessions, surgery/procedure, different
site/organ, incision or excision, injury treated
that were not part of the previously reported
procedure. The same physician does these other
procedures on the same day after performing the
initial procedure scheduled for.  
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Modifier 59 - Are You Using It Correctly?
Are You Using Modifier 59 Indiscriminately? The
National Correct Coding Initiative (NCCI)
promotes the usage of correct coding and prevents
improper payment often leading to the conduct of
audits. However, to bypass the NCCI edits, the
practices often misuse the modifiers. Whether it
is done by purpose or mistake, a practitioner has
to be mindful of not using Modifier 59
indiscriminately. Undoubtedly, the practices
append modifier 59 to a diagnostic procedure
performed following a therapeutic procedure.
However, when the diagnostic service is part of
the therapeutic procedure, the modifier is used
arbitrarily.
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Modifier 59 - Are You Using It Correctly?
Who Can Use The Modifier? In a practice, one
needs to be aware that only a coder or provider
of the service who has access to the patient's
chart can add the modifier 59. It can never be
used by the biller, even when the biller knows
that without the modifier will result in claim
rejection or bundling. You have to go back to
the service provider when you believe Modifier 59
is omitted from the claim as a biller. You should
always have substantial evidence to get back the
Modifier 59 claim. What Are The Guidelines For
Using Modifier 59? You can easily find the
guidelines for using Modifier 59 in detail at the
Medical Learning Network. But the basic
principles of the Modifier 59 are For appending
Modifier 59, new diagnosis is to be made A new
diagnosis does not qualify for Modifier 59 if new
treatment does not follow The modifier should
not be used to bypass the edit when the above
criteria fail to meet
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Modifier 59 - Are You Using It Correctly?

• Conclusion
• Use the Modifier 59 Correctly Get the Timely
  Claims!
• The improper use of a modifier is not limited
  only to Modifier 59. In fact, the practices often
  use other modifiers inappropriately such as 24,
  25, 50, 51, and 76. These modifier coding
  mistakes can easily be avoided when it is being
  done by a professional medical billing
  company such as 24/7 Medical Billing
  Services. This is one of the best alternatives,
  i.e., to connect with experts who are
  well-trained in the medical coding and stays at
  the top of the changes done into this coding
  system, so that your claims will never fail or
  come under audit because of overbilling.

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1 888-502-0537
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Modifier 59 - Are You Using It Correctly?
About 24/7 Medical Billing Services 24/7
Medical Billing Services is the nations leading
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services to more than 43 specialties across the
entire 50 states. You can rely on us for
end-to-end revenue cycle management. We guarantee
up to 10-20 increase in the revenue with cost
reduction of your practice for up to
50.  Media Contact Hari Sudan,  24/7 Medical
Billing Services, 16192 Coastal Hwy, Lewes, DE
19958 Tel [phone] Email -
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