A modifier in the right place at the right time is likely to get you a prompt and good reimbursement. You use one of the most key modifiers – modifier 59 so often that you think you know everything there is to know about it. Evaluate essential facts about modifier 59 and avoid hitting a blank wall before it is too late.
Guideline 1: Know modifier 59’s criteria when you see it
The right combination of a podiatrist’s procedure and a modifier can make or break your claim. If you want to be able to interpret a modifier correctly, read it like a story. Through modifiers, payers know what transpired during a procedure without having to read every operative report.
In this case of modifier 59, it indicates that a significant, separately identifiable procedure has been carried out on the same day as another procedure and often times during the same operative session. This modifier encompasses treatment for primary, unrelated problems and may represent session or a different procedure site.
Guideline 2: Do not overuse modifier 59
You should use caution when using modifier 59 and be sure another modifier is not more apt. In CMS memo A-00- 35, you will discover that anatomical or bilateral modifiers may be more apt than 59. In those examples where an anatomic or bilateral modifiers is not apt, modifier 59 may be apt. Go for the most comprehensive code on the first claim line without a modifier. On subsequent lines, report the code with modifier 59 and the unit of service equal to one.
Guideline 3: Draw the line between modifiers 59, 51
Do not confuse modifier 59 with 51, which is used to identify secondary ‘allowable’ procedures or services provided along with the primary procedure.
Some coders think of modifier 51 as an indicator to payers that multiple procedures were done during one operative session, while modifier 59 as more of a bundling/unbundling modifier, which is typically used to indicate that procedures normally consider components of another are in certain cases to be looked at ‘individually’.
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