Modifier 59 are you using it correctly

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Modifier 59 - Are You Using It Correctly?

Did you know one of the main reasons for claim denials and revenue
loss is the incorrect usage of modifiers?
Undoubtedly, medical bills are being claimed in a combination of codes
for the services performed in the medical practice. But that is not all
required. The accurate coding of such corresponding treatment
modifiers is mandatory to ensure the reimbursement of these claims,
including Modifier 59 (Distinct Procedural Service). In fact, the claim
form also needs to have diagnosis codes along with proper ICD 10
codes.
If you are wondering why, you should be concerned about whether you
are using Modifier 59 correctly, the reason is that it is one of the most
misused modifiers. Unfortunately, you would not be alone and lose
your revenue for the failure to use Modifier 59 correctly.
Read more…

What Is Modifier 59 Used For?
Typically, Modifier 59 indicates that more than one procedure is
performed on the patient in a single visit. But such procedures should
be on the different part of the bodies.
However, at times, it is used to bypass the edit system of the
insurance carrier and avoid being bundled with another service on the
same claim.
Going by the guidelines, it should never prevent a service from getting
bundled with the other.
Modifier 59 is developed to indicate a physician's service on the
patient during the same visit whereby the procedures are independent
of each other. Such modifier helps in reporting the services usually
performed together, but it can be done under certain circumstances,
as deemed fit by the physician.

Are You Adding Modifier 59 Correctly?
As a claimant, you must be aware that Modifier 59 is used correctly
with other modifiers. For instance, you cannot include Modifier 59
with Modifier 76. Thereby, your claim will get rejected altogether.
The reason is that Modifier 76 is used for stating the same
procedure being performed on the patient multiple times on the
same day by the same physician after the initial consultation.
Whereas Modifier 59 indicates different sessions,
surgery/procedure, different site/organ, incision or excision, injury
treated that were not part of the previously reported procedure. The
same physician does these other procedures on the same day after
performing the initial procedure scheduled for.

Are You Using Modifier 59 Indiscriminately?
The National Correct Coding Initiative (NCCI) promotes the usage
of correct coding and prevents improper payment often leading to
the conduct of audits. However, to bypass the NCCI edits, the
practices often misuse the modifiers.
Whether it is done by purpose or mistake, a practitioner has to be
mindful of not using Modifier 59 indiscriminately.
Undoubtedly, the practices append modifier 59 to a diagnostic
procedure performed following a therapeutic procedure. However,
when the diagnostic service is part of the therapeutic procedure, the
modifier is used arbitrarily.

Who Can Use The Modifier?
In a practice, one needs to be aware that only a coder or provider of
the service who has access to the patient's chart can add the
modifier 59. It can never be used by the biller, even when the biller
knows that without the modifier will result in claim rejection or
bundling.
You have to go back to the service provider when you believe
Modifier 59 is omitted from the claim as a biller. You should always
have substantial evidence to get back the Modifier 59 claim.
What Are The Guidelines For Using Modifier 59?
You can easily find the guidelines for using Modifier 59 in detail at
the Medical Learning Network.
But the basic principles of the Modifier 59 are:
For appending Modifier 59, new diagnosis is to be made
A new diagnosis does not qualify for Modifier 59 if new treatment
does not follow
The modifier should not be used to bypass the edit when the above
criteria fail to meet

Conclusion:
Use the Modifier 59 Correctly – Get the Timely Claims!
The improper use of a modifier is not limited only to Modifier 59. In
fact, the practices often use other modifiers inappropriately such as
24, 25, 50, 51, and 76. These modifier coding mistakes can easily be
avoided when it is being done by a professional medical billing
company such as 24/7 Medical Billing Services. This is one of the
best alternatives, i.e., to connect with experts who are well-trained in
the medical coding and stays at the top of the changes done into this
coding system, so that your claims will never fail or come under audit
because of overbilling.

About 24/7 Medical Billing Services:
24/7 Medical Billing Services is the nation’s leading medical billing
service provider catering services to more than 43 specialties across
the entire 50 states. You can rely on us for end-to-end revenue cycle
management. We guarantee up to 10-20% increase in the revenue
with cost reduction of your practice for up to 50%.
Media Contact:
Hari Sudan,
24/7 Medical Billing Services,
16192 Coastal Hwy, Lewes, DE – 19958
Tel: + 1 -888-502-0537
Email - info@247medicalbillingservices.com

Modifier 59 are you using it correctly

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