6/23/2014 – Proper use of Modifier -59

Question: When is it appropriate to use modifier -59 and should we be adding it ourselves to the code?    Answer: The -59 modifier is often used on post-op pain blocks to show they are separate from the primary mode of anesthesia. The modifier is assigned by the coding department when it is appropriate based on Medicare’s coding edits.   As a point of interest, the CPT Manual defines modifier 59 as follows: “Distinct Procedural Service:Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.   Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. “


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