# 59 Modifier - most expensive



## TJONES (Feb 25, 2014)

Having a debate in the office.  When coding multiple procedures I have was taught to code most expensive to least expensive and use the  59 on the second and third procedures because of the reduction in payment.
Another coder said you use the 59 on specific procedures and order does not matter.
Any feed back on how this should be done?


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## AB87 (Feb 25, 2014)

Yes you must put them in order from Highest to Lowest. Ive coded Derm with a lot of Coding Combinations (office procedures). If they Bx (11100) in one area then LN2 (17110) Another site, you would use -59 depending on the price difference.


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## mitchellde (Feb 25, 2014)

you do list the procedure in RVU order highest to lowest, the 59 modifier however goes on the code that needs it.  That is not always the code with the lower RVU.  I have had several occasions when the component code had the higher RVU but it is also the one that needs the 59 modifier.


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## CatchTheWind (Mar 13, 2014)

Debra is correct about having to put the 59 modifier on the "code that needs it."  

The way to find out which code needs it is to use a tool such as DermCoder or to look at the CCI Edits, which you can download from https://www.cms.gov/apps/ama/licens...NationalCorrectCodInitEd/downloads/ccipra.zip .  Once you've downloaded it, find your two codes in a Column 1/Column 2 match; the 59 goes on the code that is in column 2.


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