Medical Billing Modifier 59 Has Been Causing Trouble

Recently, the contractors for the Centers for Medicare and Medicaid Services have been on the lookout for any modifiers that have been used incorrectly. The cause for alarm is that it has recently been shown that even though modifiers are a great asset to medical billing, there are a select few modifiers that are not used in the proper fashion. Of all of the modifiers that have been used incorrectly from time to time, the one that has seemed to have been the most questionable is modifier 59.

Now, this is not just any random investigation just because there have been a few problems. Studies by the U.S. Office of the Inspector General have actually shown that this particular modifier has been the cause of overpayments to certain practices in excess of $59 million dollars. For obvious reasons, since such findings have been recognized, contractors such as those for Medicare will be looking much further into the use of modifier 59 whenever it is used on a medical billing submission.

The best way to safely use modifier 59 is only when there are a pair of procedures performed that actually have nothing in common. This way, modifier 59 will be able to show that these are two totally different and separate treatments. The following of certain guidelines could work in your favor when you are using modifier 59 in the future. If you are in need of another example, modifier 59 can be used when in regards to certain group therapy sessions. Basically, as long as both one-on-one therapy sessions and group therapy sessions meet guidelines of the Current Procedural Terminology definitions this modifier can be used.

The Centers for Medicare and Medicaid Services play an important role in the medical field and should be regarded as such when you are taking care to deal with your billing. Not only will teaching your staff of medical billers the proper use of modifier 59 help your practice, but it will also save quite a big chunk of money for the United States government every single year.

View all Articles by: Melissa Clark, CCS-P