How to use cpt modifier 59 (distinct services)

How to apply Modifier 59?

Modifier 59 is always a tricky modifier to use while coding charts. Since, it is use to differentiate between two procedure or distinct procedures, one always gets confuse when to use this modifier between any two related procedure since we have many other modifiers also which can be used in place of 59 depending on the documentation by the physician.
According to CPT, modifier 59 is used to support a different session, a different procedure or surgery, a different site or organ system, a separate incision or excision, a separate lesion, or a separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual.

Read also: Learn about New modifiers  of 2015 along with 59

Different scenarios to use modifier 59

Case 1: when there are different cpt code and have CCI edit. In this case the cpt with low RVU value has to be appended with 59 modifier.
For example: 
When MRI of brain/head in done with MRA of brain/head on same day one has to append 59 modifier to CPT MRA of brain/head.
MRI brain w/o contrast 77051 done with MRA of brain w/o contrast 70544 on same day then 59 modifier is added to MRA brain as per CCI edit (70544-59).
Also for X-rays where are different in the level of views we can append 59 modifier to the lower level of cpt.
For example: 71020 for two view chest and 71010 for one view chest performed on same day. In such case 59 will be added to 71010-59.

 Read also : Superb tips for coding Follow-up visit ICD 10 codes


Case 2: when there is same CPT but procedure is done on different location. In this situation one has to remember to append 59 mod to any one of the cpt. In such situation many coders tend to use 76 modifier since they will think of same cpt and hence same procedure is performed . But here the story is little different because the modifier 59 stands for distinct services we have to give 59 modifier to any one of this cpt in this case just to show it has performed on different anatomic site but with same cpt.
For example:
Cpt 93970 & 93971: both these cpt states duplex scan of extremity veins: complete or bilateral study /unilateral or limited study. 




Read also: Do and don't of new modifiers of 2015 X-{EPSU}

Hence, when there is report having Duplex scan of upper extremity veins bilateral and the other report with Duplex scan of lower extremity veins bilateral, one has to land up with the same cpt code 93970.
So, the result will both report will be coded as 93970 only, but just to distinct the first procedure from the other procedure one has to append 59 modifier to any one cpt since the procedure is done on different anatomic site (upper extremity & lower extremity).
Also, when someone is coding Interventional radiology procedure, there are different vascular families which one has to code according to each vascular family for selective catherization.
For example:
If in a report physician has done selective catherization in two vascular families. First he has done selective catherization of common iliac artery (36245) and then he has done selective catherization of superior mesenteric artery (36245), so both are first order catherization codes hence 36245, to differentiate first procedure with the other one has to append 59 modifier to the other cpt since the procedures are done at different vascular family or different anatomic site hence appended with distinct services modifier 59.



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