General Surgery Coding Alert

Question: One of the coders in our department insists that we can use modifier 59 if the surgeon performs a "separate procedure" for a diagnosis different from the diagnosis that prompted the primary procedure. In looking over Medicare and CPT guidelines, however, I see nothing to support this. Is a separate diagnosis enough to warrant modifier 59? Maine Subscriber Answer: According to CPT instructions and Chapter 1 of the national Correct Coding Initiative (CCI), you may append modifier 59 (Distinct procedural service) when the physician: - sees a patient during a different session - treats a different site or organ system - makes a separate incision/excision - tends to a different lesion - treats a separate injury. Although the diagnosis that prompts the follow-up procedure with modifier 59 may be different from the diagnosis that prompted the primary procedure, a different diagnosis by itself does not justify using modifier 59. [...]