National Correct Coding Initiative (NCCI) - Modifier 59 Reminder

This article is a reminder that modifier 59 should only be used if no other suitable modifier is available. Evaluate other modifiers, such as RT/LT to identify right and left, FA, F1-F9 to identify fingers, TA, T1-T9 to identify toes and E1-E4 to identify eyelids. Also check repeat modifiers (76, 77 or 91) to avoid duplicate denial.

It is important that providers follow the NCCI instructions (link below), before appending modifier 59. It can only be appended if the indicator is “1”.

Appropriate Uses of Modifier 59:

  • Different session (documentation must support)
  • Different procedure or surgery
  • Different sites or organ systems: If two procedures performed at separate anatomical sites or separate patient encounters on same date of service
  • Separate lesions or injuries not ordinarily performed on same day by same individual
  • Second initial injection procedure when protocol requires two separate sites or when the patient returns for a separately identifiable service

Inappropriate Uses of Modifier 59:

  • Cannot bypass NCCI Procedure-to-Procedure (PTP) edit
    • Unless proper criteria with indicator one “1”
  • NCCI tables indicator of zero (0) - cannot unbundle
  • Valid modifier exists to identify services (repeat modifiers)
  • Documentation does not support separate and distinct
  • Indicate multiple injection administrations of same drug (use repeat modifiers)
  • When used with E/M service
  • To report separate and distinct E/M service with non-E/M procedure performed on the same date (append modifier 25)

Resources:

 

            Last Updated Fri, 29 Jan 2021 20:39:59 +0000