Wiki Modifier 59 issue

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azdgirl

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Is it correct to add modifier 59 on all procedure codes that you are billing out.
This is being done on the primary procedures add-on codes and every code for a spine surgery.
 
I believe when I was studying for my CPC exam, it said no modifiers on add-on codes. However, Medicare requires modifiers on add-on codes...
I have not seen commercial payers require it.

(Of course which modifiers will depend on the codes themselves)
 
No, modifier 59 should not be added to ALL codes that are billed out. Primary procedures and add-on codes should not need that modifier. It would depend on what is being billed as the subsequent codes. Using modifier 59 on everything all the time could very well trigger an audit as well.
 
Absolutely not correct to add modifier 59 on all procedure codes that are going out!
I'm alarmed when I hear people saying to "add 59 modifier because it is what gets the claim paid". This mindset needs to be eradicated.

Azdgirl, take heed to what the other posters have provided and do your homework. It's can be a lengthy and arduous task, but in the end you'll be better able to sleep at night.

You're wise to seek advice...
 
Greetings!

Who is tellilng you to append modifier 59 to all CPT codes?
Is this an Epic-related problem? (Our system kicks back add-on codes wanting mod-59, but we are somewhat new in Epic & hopefully, this will be fixed soon-ish! Quite annoying.)

You may refer to the CPC coding manual for directions on when or under what circumstances to append modifier 59. You may also want to refer to one of Deborah Griner's fine textbook on modifiers.

This modifier is never used on first listed CPT codes; it is not appended to add-on codes and not it is appended in cases where multiple procedures guidelines apply.

Agree with past posts - it takes some research to learn which subsequent or secondary CPT codes allow modifier 59, but it is valuable information to have at your fingertips!

Modifier 59 is closely watched by all payors - your employer does not want an audit of your billing practices.

Best of luck to you,
pat kidd, cpc, cgsc
19 Aug 2014
 
Modifier 59

Could anyone tell me what modifier to use for spirometry done at time of office visit?
 
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