Steps to Follow Before Choosing Modifier 59

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• Steps to Follow Before Choosing Modifier 59

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Steps to Follow Before Choosing Modifier 59

• The National Correct Coding Initiative (NCCI)
  maintains a list of procedures that are bundled
  and therefore cannot be billed at the same date
  and time. Many billers do not really understand
  importance of modifiers or when they need to be
  used. A modifier should never be used just to get
  higher reimbursement or to get paid for a
  procedure may bundle with another code. Modifiers
  are used to help communicate these unique
  circumstances and are necessary to bypass the
  NCCI edits. You should follow some steps before
  choosing modifier 59.
• Modifier 59 is an important modifier and billers
  use it for a variety of circumstances however,
  it is an understanding that to be applied
  incorrectly to bypass the NCCI edits.
• Steps to Follow Before Choosing Modifier 59
• If your surgeons documentation shows you that a
  surgeon performed multiple procedures on the same
  patient on the same day then very first thing you
  should do is to check CCI edits for any bundled
  codes. While checking bundled codes take care of
  Centers for Medicaid and Medicare Services (CMS)
  guidelines.
• For codes with an indicator of 1, agree if
  modifier 59 applies. The distinct in Distinct
  procedural service means the services which you
  want to unbundle were performed at a different
  anatomical site or organ system, while surgical
  session, incision, lesion, or injury.

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Steps to Follow Before Choosing Modifier 59

• Next, consult any payer-specific guidelines.
  Modifier 59 should only be used if there is no
  other appropriate modifierits the last resort.
  For example, LT, RT, and Medicares X modifiers
  (XS, XE, XP, and XU) offer more specificity than
  modifier 59. If a more appropriate modifier
  applies, use it instead.
• Consult any payer-specific guidelines before
  using modifier 59. Modifier 59 should only be
  used if there is no other appropriate modifier.
• If you have found that the modifier 59 is perfect
  fit, append it to the secondary procedural code.
• According to the CCI edits, 29806 (Arthroscopy,
  shoulder, surgical capsulorrhaphy) and 29820
  (synovectomy, partial) are bundled with an
  indicator of 1. Since the procedures were
  performed on a different anatomical site, they
  qualify as distinct procedural services.
• Medisys staff is highly trained and successful in
  increasing physicians collections. Click here to
  connect with our medical billing manager
  info_at_medisysdata.com or you can reach out to us _at_
  302-261-9187.
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