Urology Coding Alert

Save modifier 59 as a ‘last resort’ answer to getting paid. 

When you see a modifier indicator of ‘1,’ do you automatically turn to modifier 59 (Distinct procedural service) to explain your urologist’s clinical circumstances for performing both services in one session? If so, you could be setting your claim up for denial. 

This is a common pitfall that even experienced coders fall into at times. But with increasing payer scrutiny on modifier 59, you want to be sure you only use it when no other modifier better describes the clinical scenario. 

Use this flowchart to quickly assess some of the most common modifier assignments before you pick 59.