59 - JF Part A
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
- CMS Internet Only Manual (IOM), Medicare Contractor Beneficiary and Provider Communication Manual, Publication 100-09, Chapter 5, Correct Coding Initiative, section 20.4
- National Correct Coding Initiative Edits
Last Updated Dec 12 , 2022
