Correct Use of Modifier -59 In Your Medical Billing

Correct Use of Modifier -59 In Your Medical Billing

Many medical billing require modifiers to justify and explain why a certain service was done or billed. Modifier 59 many times is forgotten or misused. In order to receive correct payment when medically billing, the correct use of modifier 59 necessary.

When medically billing, modifier 59 means that a separate service has been performed on the same day as another , but that they are completely separate and should get separate reimbursement. This could mean a different patient visit, surgery, separate lesion, different site, or a completely separate injury.

Here is an example of correct medical billing of modifier 59. If a patient comes in for stitches in the morning because his finger is cut, and then comes back in the afternoon because he broke his hand, you might think these two are related. What if I told you, he cut his finger carving a turkey for Thanksgiving and later broke his hand because he was wrestling with his kids? It is obvious to see these were completely different accidents that happened on the same day, but different times.

Medical billing practices would require the use of modifier 59 to get separate reimbursement. If modifier 59 was not on the bill, it would appear to the insurance company he broke his hand and cut it at the same time, therefore, would not pay for two E&M sessions.

Any medical billing company would know the correct rules for this procedure. If modifier 59 is not indicated, one of the claims would be denied payment. This would force an office to submit another claim with the correct indications or write a letter of medical necessity. Either way, it is a waste of money because it could have been avoided with correct medical billing practices. Outsourcing your medical billing to medical billing firms can eliminate these errors and save your practice money.

View all Articles by: Melissa Clark, CCS-P