Modifier 59

Definition

Distinct Procedural Service

Appropriate Usage

  • Append when documentation indicates two separate procedures performed on same day by same physician
    • Represented by a different session or patient encounter, different procedure or surgery, different site, or separate injury (or area of injury)
  • Append to secondary, additional or lesser procedure of combinations listed in National Correct Coding Initiative (NCCI) edits
    • Indicate 0 means a Correct Coding Modifier (CCM) is not allowed
    • Indicate 1 means a Correct Coding Modifier (CCM) is allowed
    • Indicator 9 means the use of a CCM is not specified
  • Append when there is NO other appropriate modifier
  • Append on second initial injection procedure code when IV protocol requires two separate IV sites or when patient has to come back for a separately identifiable service

Inappropriate Usage

  • Code combination not appearing in NCCI edits
  • Submission of E/M Codes
  • Submission of weekly radiation therapy management codes (CPT 77427)
  • The NCCI tables lists procedure code pair with a modifier indicator of "0"
  • Documentation does not support the separate and distinct status
  • Exact same procedure code performed twice on same day
  • Multiple administration of injections of same drug
  • When a more specific modifier exists to identify the services

Resources

 

Last Updated Fri, 28 Feb 2020 13:05:45 +0000