Orthopedic Coding Alert

The August 2002 Orthopedic Coding Alert featured a "Modifier of the Month" article regarding modifiers -59 (Distinct procedural service) and -51 (Multiple procedures) in which we stated that using modifier -59 should not result in a reimbursement reduction and advised coders to appeal denials when payers reduce fees due to modifier -59. However, this may not always be the case.

According to Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopaedic Associates in New Brunswick, N.J., "Appending modifier -59 elicits mixed results with regard to reimbursement. In some instances, a multiple surgical procedures reduction is perfectly appropriate and, at other times, it is not."

For example, payers may appropriately reduce payment when modifier -59 is used to indicate that an arthroscopic chondroplasty (29877) was performed in a separate compartment than an arthroscopic meniscecto-my (29881).

However, Stout advises, "When modifier -59 is used to indicate that procedures were performed at separate operative sessions on the same date of service, or that the procedures were completely unrelated but likely to be bundled, such as an ORIF of a fractured distal radius on the right (25620) performed with a reduction of a distal radius fracture on the left (25605), then I would certainly appeal if a payer reduced the second procedure."