Medical Billing Tips for Modifier 59

Using a modifier incorrectly can cost you in terms of reimbursements and time. Carriers are closely scrutinizing medical billing claims for incorrect usage of modified 59. There are two main areas that you can concentrate on to avoid getting his with denials or pay backs and insure that you use the modifier correctly.

A study of the OIG found a 40% error rate for modifier 59 and you can double check your billing. First of all, in order to use modifier 59 there must be services performed at separate regions. Fifteen percent of the OIG’s audited claims using modifier 59 had procedures that weren’t distinct because “they were performed at the same session, same anatomical site, and/or through the same incision,”.

Be certain that the physician has worked on two distinct areas of the body or more and make sure that your medical billing documentation backs it up completely. This will avoid your claims being bundled as one procedure and lessening the reimbursement rates on your medical billing claims.

Another valuable tip for using modifier 59 correctly will involve the secondary code. Make sure that you use 59 on the secondary code and once again make sure your medical billing documentation is iron clad. Each edit for the NCCI will consist of code 1 and code 2, use 59 in the code 2 column where appropriate.

If you’re missing using modifier 59 on your medical billing claims, you’re missing out on valid reimbursements for services performed, make sure you’re getting the maximum reimbursements for your medical billing claims and stay on top of the latest trends or it may be time to consider outsourcing your medical billing to a company that can stay ahead of the latest changes for you.

View all Articles by: Kathryn E, CCS-P - Retired