Quick Tip: Reinforce Mod 59 Claims: Here’s Why

Text accompanying the descriptor for modifier 59 (Distinct procedural service) in Appendix A of CPT 2008 now states unequivocally, "Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual." This differs from past versions of CPT, which specified merely, "Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances."
With round after round of modifier 59 crackdowns by the HHS Office of Inspector General, Medicare payers and others, an emphasis on the necessity of documentation to support modifier 59 claims isn’t surprising.
The actual conditions for using modifier 59 appropriately, however, haven’t changed. In fact, Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CHCC, says she’s been teaching all along that your documentation must support the 59 modifier.
"They [the AMA via CPT] are just clarifying because there’s been so much abuse on 59," Cobuzzi adds.
Keep watching: For complete information on applying modifier 59 accurately and successfully, look to an upcoming Ambulatory Coding and Payment Report.

- Published on 2007-11-27