Usage of Modifier 59

May 13, 2008 | Medical billing basics

Modifier 59

Key Points to Remember:

When using this modifier, Medical Documentation is vital and essential to support medical necessity. This must be well-documented on the patient’s medical record.

  • This modifier may represent a different body site or organ system.
  • This modifier may represent a separate lesion.
  • This modifier may represent a different area of injury.
  • This modifier may represent a different procedure.
  • This modifier may represent a separate incision or excision.
  • This modifier represents a distinct and independent procedure/surgery/encounter from other services performed.Sample Encounters:

    • Sample 1: Physical Therapy

    A physical therapist treat a patient with different problem. One for his neck and one for his back. During the same session, he did a Therapeutic Exercises (CPT 97112) 15 minutes each site (back and neck).

    Code first line 97112 without Mod- 59

    Code second line 97112 with Mod- 59

    >>>> make sure you point the right diagnosis on each line.

    Sample 2: Dermatology

    A Dermatologist performs simple repair of a superficial wound to the right arm and also performs a debridement of another site but on the same arm

    CPT code Modifiers
    CPT modifier
    CPT modifiers
    ASC modifier SG
    CPT modifier 51
    CPT modifier 62 and 66
    CPT Modifier 22 and 51
    CPT modifier 22 and 24
    CPT modifier 52 and 53
    CPT modifier 26 and TC
    CPT modifier 59
    CPT anesthesia modifier codes
    ASC modifiers
    Modifier 59
    CPT modifier 25
    CPT modifier 24
    CPT modifier 57
    CPT modifier 78
    CPT Modifier 79
    Surgical modifiers
    CPT modifier 58
    CPT billing codes
    CPT codes and HCPCS codes
    What is Medical coding

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