Modifier 59 Fact Sheet
- Distinct Procedural Service identifies procedures/services not normally reported together, but appropriately billable under the circumstances.
- Documentation indicates two separate procedures performed on the same day by the same physician
- Represented by a different session or patient encounter, different procedure or surgery, different site, or separate injury (or area of injury)
- Use Modifier 59 with the secondary, additional or lesser procedure of combinations listed in National Correct Coding Initiative (NCCI) edits.
- Use Modifier 59 when there is NO other appropriate modifier.
- Use Modifier 59 on the second initial injection procedure code when the IV protocol requires two separate IV sites or when the patient has to come back for a separately identifiable service.
- Code combination not appearing in the NCCI edits
- Submission of E/M Codes
- Submission of Weekly radiation therapy management codes (CPT 77427)
- The NCCI tables lists the procedure code listed with a modifier indicator of "0"
- Documentation does not support the separate and distinct status
- Exact same procedure code performed twice on the same day
- Multiple administration of injections of the same drug
- If a valid modifier exists to identify the services
- NCCI listings can be found on the CMS National Correct Coding website.
- Medicare considers two physicians in the same group with the same specialty performing services on the same day the same physician.
Distinctly different Column 1/ Column 2 CCI Edit
Modifier reported incorrectly for CCI edit