modifier -59

modifier -59

A code added to CPT coded bills (in the USA) for professional healthcare services which indicates to third-party payers that a procedure or service performed was distinct or independent from other procedures or services performed on the same day on the same patient in the same facility by the same provider.
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You will note that the colpopexy codes 57283 and 57282 are bundled into all vaginal hysterectomy codes, and although you can use a modifier -59 to bypass this edit, you must meet the criteria for doing so.
When multiple lesions are biopsied or removed during a single visit, file multiple claims, using modifier -59 for distinct (separate) procedural services.
Use of Modifier -59 to Bypass Medicare's National Correct Coding Initiative Edits.
Modifier -59 is used for distinct and independent surgical services on the same day For example, this could be used for a Burch procedure performed transabdominally for stress incontinence at the same time as a posterior colporrhaphy is done for defecation dysfunction.
Using modifier -59 (distinct procedural service) indicates that the physician injected different muscle groups, thus overriding the software edit.
Until then, the modifier -59 should continue to be used by most clinicians.
Here are the new modifiers, with an example of their use with currently bundled procedures that allow a modifier -59 to be used under certain circumstances:
A modifier -59 (Distinct Procedural Service) can be reported to bypass these edits, but the payer will request documentation to ensure that the criteria for using this modifier apply.
In 2011, you would have reported each separate repair with a modifier -51 (Multiple procedures); in 2012, however, you report modifier -59 (Distinct procedural services) instead when you have repaired multiple wounds.
If the codes can be billed together, should I use a modifier -59 (distinct service)?