Linda Barbar asked:
Dear Laureen;
your videos helped me to pass CPC ....so thank you for that
now i am facing a problem with modifier 59 ....
modifier 59 is used in these cases:
1.different session
2\. different procedure or surgery
3\. different site or organ system
4\. separate incision/excision
5\. separate lesion; or separate injury
i understand all the above cases except the second one .......... what do they mean by different procedure or surgery? i mean they are always different procedure that we need to add a 59 to one of them........
i have this example .......... a patient had a Lap BSO and appendectomy .......... according to NCCI edit these are bundled procedure ....... so can i use mod 59 in this case? since they are different procedure ?
another example is hemicolectomy with hernia repair ..... hernia repair code is bundled into hemicolectomy; same thing should i use modifier 59? the patient has colon cancer and while they are doing hemicolectomy they found the hernia and repair it ........ so should i use 59 or not ?
its really confusing .........
hope you can help me to understand mod 59 better
thank you
Linda
Answer:
**Modifier 59 - Distinct Procedural Service**
Under certain circumstance; it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M service performed on the same day. Modifier 59 is used to identify procedures/services; other than E/M services; that are not normally reported together; but are appropriate under the circumstances. Documentation must support a different session; difference procedure or surgery; different site or organ system; separate incision/excision; separate lesion; or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However; when another already established modifier is appropriate it should be used rather than modifier 59. Only if no more descriptive modifier is available; and the use of modifier 59 best explains the circumstances; should modifier 59 be used.
Based on the Modifier 59 description above; you are correct in that this modifier is used for:
* Different surgical sessions
* Different procedure or surgery
* Different sites or organ systems
* Separate incisions/excisions
* Separate lesions
* Separate injuries
"Different procedure or surgery" is often interpreted to mean procedures or surgeries that do not share access and/or closure or meet on of the other criteria above (different organ system; etc).
For the specific examples you asked about above:
1. A patient had a laparoscopic bilateral salpingo-oophorectomy (BSO) [CPT
Dear Laureen;
your videos helped me to pass CPC ....so thank you for that
now i am facing a problem with modifier 59 ....
modifier 59 is used in these cases:
1.different session
2\. different procedure or surgery
3\. different site or organ system
4\. separate incision/excision
5\. separate lesion; or separate injury
i understand all the above cases except the second one .......... what do they mean by different procedure or surgery? i mean they are always different procedure that we need to add a 59 to one of them........
i have this example .......... a patient had a Lap BSO and appendectomy .......... according to NCCI edit these are bundled procedure ....... so can i use mod 59 in this case? since they are different procedure ?
another example is hemicolectomy with hernia repair ..... hernia repair code is bundled into hemicolectomy; same thing should i use modifier 59? the patient has colon cancer and while they are doing hemicolectomy they found the hernia and repair it ........ so should i use 59 or not ?
its really confusing .........
hope you can help me to understand mod 59 better
thank you
Linda
Answer:
**Modifier 59 - Distinct Procedural Service**
Under certain circumstance; it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M service performed on the same day. Modifier 59 is used to identify procedures/services; other than E/M services; that are not normally reported together; but are appropriate under the circumstances. Documentation must support a different session; difference procedure or surgery; different site or organ system; separate incision/excision; separate lesion; or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However; when another already established modifier is appropriate it should be used rather than modifier 59. Only if no more descriptive modifier is available; and the use of modifier 59 best explains the circumstances; should modifier 59 be used.
Based on the Modifier 59 description above; you are correct in that this modifier is used for:
* Different surgical sessions
* Different procedure or surgery
* Different sites or organ systems
* Separate incisions/excisions
* Separate lesions
* Separate injuries
"Different procedure or surgery" is often interpreted to mean procedures or surgeries that do not share access and/or closure or meet on of the other criteria above (different organ system; etc).
For the specific examples you asked about above:
1. A patient had a laparoscopic bilateral salpingo-oophorectomy (BSO) [CPT
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