Medicare has expanded the modifier -59
into additional modifiers to further explain the situation.
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.
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.
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.
Another Medicare coding change that may affect ObGyns is the addition of new Medicare modifiers that are intended to eventually replace the modifier -59. This new list of modifiers will need to be appended to bundled procedures to more clearly explain why the secondary procedures should be paid separately.
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.
Because both of these codes are CPT "separate procedures," a modifier -59
should be added to indicate that a distinct procedure was performed.
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.
When I checked the bundling software, it lists these codes as mutually exclusive, with 51795 having an indicator of "1" and 51797 a "9." If the codes can be billed together, should I use a modifier -59