Wiki Medicare Modifier 59 changes

[treinemer]

One of our follow up people was in on a Medicare Teleconference and was given the following link for Noridian regarding changes to modifier 59 retro to 7/1/13.

Our initial response was that Modfier 59 was no longer to be used on multiple procedures, which of course was pretty distressing considering how much it is used and that this ruling is almost a month retro.

After reading it several times a co-worker noticed that it does say "repeat procedure", which seems would then apply to things more like biopsies and other procedures that would require the same code multiple times.

We would just like to verify that we are on the right track with this or if anyone else has thoughts on this latest change.

Thanks!


https://www.noridianmedicare.com/partb/claims/alerts/082313.html
It reads:
Part B Providers Submitting Modifier 59
Applies To: Part B Providers Submitting Modifier 59

Procedure Code(s): N/A

Background
Per a system-process change as of 07/01/13, modifier 59 is no longer considered a valid repeat modifier. Procedures billed with modifier 59 will be denied as exact duplicates.

Noridian Action
8/22/13 – No action needed.

Provider Action Needed
To avoid these denials on repeat procedures, you may bill using a 76 or 91 modifier, whichever is most appropriate.

Modifier 59 - Distinct Procedural Service

Modifier 76 - Repeat Procedure by Same Physician

Modifier 91 - Repeat Clinical Diagnostic Laboratory Test to Obtain Multiple Results


Date Reported: 08/22/13

Date Resolved:

Tracking#: 130823001

 

[magmae]

1st - 59 mod is not used for a 'repeat procedure'
2nd - 59 is used for a 'distint and separate procedure'....which medicare clearly defines when it is to be used. For example - multiple stent placements - these are not repeat procedures and should also state which duct/vessel/artery ect they are placed or removed from so to use a 76 would be incorrect...

I have not seen/heard anything stating not to use this but even so, if the writing states not to use for 'repeat' procedures then you have to look at proper coding and modifier usage.

A true repeat procedure would use another modifier such as 76. Written words are black and white, thus, I would look at when the 59 is being used and verify if it was correctly coded...Otherwise, I would argue Medicare guidelines regarding its usage. Unless they(Medicare) alter their policy/guidelines in the manual all other info is basically bogus when it comes to Medicare....

 

[Yoody65]

Noridian Medicare Website - Mod 59

This is what was posted on the Noridian MC website:

Applies To: Part B Providers Submitting Modifier 59
Procedure Code(s): N/A

Background
Per a system-process change as of 07/01/13, modifier 59 is no longer considered a valid repeat modifier. Procedures billed with modifier 59 will be denied as exact duplicates.

Provider Action Needed
To avoid these denials on repeat procedures, you may bill using a 76 or 91 modifier, whichever is most appropriate.

Modifier 59 - Distinct Procedural Service
Modifier 76 - Repeat Procedure by Same Physician
Modifier 91 - Repeat Clinical Diagnostic Laboratory Test to Obtain Multiple Results
Date Reported: 08/22/13

Looks like it is only for the "repeat"