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When Do I Use Modifier - 59?

Modifier -59 - For Distinct Procedural Service

Key Points to Remember:

  1. When using this modifier, Medical Documentation is vital and essential
    to support medical necessity. This must be well-documented on the
    patient's medical record.
  2. This modifier may represent a different body site or organ system.
  3. This modifier may represent a separate lesion.
  4. This modifier may represent a different area of injury.
  5. This modifier may represent a different procedure.
  6. This modifier may represent a separate incision or excision.
  7. This modifier represents a distinct and independent
    procedure/surgery/encounter from other services performed.


Sample Encounters:

Sample 1: Physical Therapy

A physical therapist treat a patient with different problem. One for his neck
and one for his back. During the same session, (CPT 97110) 15 minutes
each site (for back and neck).

Code first line 97110 without Mod- 59  
Code second line 97110 with Mod- 59

>>>> make sure you point the right diagnosis on each line.

Sample 2: Dermatology

A Dermatologist performs simple repair  of a superficial wound to the right
arm and also performs a debridement of another site but on the same arm.

>> Modifier -59 is very useful for coding and billing dermatology services.

Sample 3: Pain Management

The pain doc performs a facet nerve block L1-L2 and an SI Injection on the
same session:

64475 x 1 unit
27096 mod -59 x 1 unit

Read more on Modifier -59 Per CMS

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