Author Topic: Modifier 59  (Read 2172 times)

asbrendle

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Modifier 59
« on: January 17, 2012, 09:26:58 PM »
At the office I work at we are torn between using the 59 modifier or not on procedures we do in office along with the E/M code. We have one who is dead set against it, stating that it is a surgical code not to be used in the office setting. We have tried coming to a consensus but we are getting no where. I have been out of practice coding and billing due to moving and other personal reasons for about 2 years, until here recently. So I am still trying to feel my way back into a coding/billing position as well as coming into an office divided over whether or not to use it. I have read it over and over and I don't think it is a surgical only code.

Help me please! I need more opinions on this modifier and when to use it so I use it correctly when coding.

Thank you!!!! 

DMK

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Re: Modifier 59
« Reply #1 on: January 18, 2012, 10:50:49 AM »
-59 means it's a distinct separate service.  In our office setting, the E/M is the evaluation.  If that evaluation prompts a service, it's coded with -59.  Say if a routine physical turns up a skin tag, and they remove the skin tag at the same appointment, that would be a -59.  If they specifically came in for skin tag removal and there was no E/M you would bill only the surgery code, no modifier.

asbrendle

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Re: Modifier 59
« Reply #2 on: January 18, 2012, 06:40:04 PM »
Thanks! That was my thought, I used to bill it that way at the old practice I worked at. But as I said the one person is pitching a fit saying that she does not look good in orange. LOL

DMK

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Re: Modifier 59
« Reply #3 on: January 18, 2012, 07:15:12 PM »
I was just re-reading your initial post.  It's not a surgical code, although it can be used in that setting. 

You could instead code the E/M with a -25 to indicate that it was a separate indentifiable service on the same day as a procedure.  Then not use the -59 for the other services.  Your notes need to back this up.  In the CPT book there is an interesting "note" that then refers to -59.

koatsj

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Re: Modifier 59
« Reply #4 on: January 19, 2012, 07:39:28 AM »
I also use modifier -25 on the E/M when a patient comes into our general surgery office for a visit and then at that time a procedure is performed in the office. Modifier -59 is not used on E/M codes. I use -59 when there are more than one procedure being performed that was distinct from the other procedure(s).

asbrendle

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Re: Modifier 59
« Reply #5 on: January 19, 2012, 07:05:28 PM »
Ok on this same note. I have to ask the following.... Say we have a patient that is coming in to be seen for lets say UTI symptoms, but has Emphysema as well so the MD orders a SO2 can we bill for the SO2 with a 59 as a separate procedure or no?

DMK

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Re: Modifier 59
« Reply #6 on: January 20, 2012, 10:34:51 AM »
Yes, but be sure to list the Emphysema in your diagnosis as well, or they will say "why the SO2 for a UTI?"