Author Topic: modifier 59  (Read 3341 times)

dekenn

  • Jr. Member
  • **
  • Posts: 85
modifier 59
« on: May 08, 2008, 01:49:47 PM »
I recently got a claim rejected that had two procedure codes on it, with the second procedure code having modifier 59, for separate, distinct service.  When I called to appeal, to Horizon BCBS, they told me that as of 1-1-08, they no longer recognize modifier 59.  When asked what modifier I should use to show two separate procedures, their response was they couldn't tell me!  Has anyone else heard of this??  I know you have to back up the use of the modifier, which I was prepared to do with the office notes, but not allowing it at all???

Michele

  • Administrator
  • Hero Member
  • *****
  • Posts: 5927
    • Solutions Medical Billing
Re: modifier 59
« Reply #1 on: May 08, 2008, 04:41:25 PM »
Hi,
   No I haven't heard of this.  It seems very strange.  I don't know how they could not recognize the 59 modifier.  I would contact your BC provider rep for your area and question them.  It just doesn't seem ok to not recognize a modifier that there is really no other modifier that does the same thing.

Let us know what you find out.  I'm curious.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Tracy

  • Newbie
  • *
  • Posts: 8
Re: modifier 59
« Reply #2 on: June 10, 2008, 09:50:04 PM »
I Bill for an ASC in Oregon, and Blue Cross of Oregon will only pay on the primary CPT code and no others, no matter what modifier I use. I don't know who your are billing for, but Modifier 59 does not work when billing B/C for an ASC

snavE08

  • Newbie
  • *
  • Posts: 2
Re: modifier 59
« Reply #3 on: July 21, 2008, 12:16:50 AM »
Hello,

I work for my local BCBS and we recognize the -59 modifier, maybe the person you contacted didn't really understand what you were asking/inquiring about.  That has happened to me many times we I have spoken to our Provider Representatives over the phone.

Pedenia

Medical Billing Forum

Re: modifier 59
« Reply #3 on: July 21, 2008, 12:16:50 AM »