Pulmonology Coding Alert

Question: Recently, I have received denials for services to which I appended modifier 59. Can you explain what I may be missing about reporting distinct procedural services? Texas Subscriber Answer: You're not alone -- modifier 59 (Distinct procedural service) is often used incorrectly. In the eyes of the Correct Coding Initiative (CCI), modifier 59's primary purpose is to indicate that the physician performed two or more procedures: • at different anatomic sites, or • during different patient encounters. Helpful: From an CCI perspective, the definition of different anatomic sites includes different organs or different lesions in the same organ. The definition, however, does not include treatment of contiguous structures of the same organ. Only use modifier 59 if no other modifier more appropriately describes the relationships of the two or more procedure codes you are reporting. Look to the CCI edits to determine when you may not report two CPT or [...]