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Radiology Coding Alert

Modifiers -51 and -59:

Under the Microscope

Modifiers -51 and -59 have similar applications to tell the insurer that you performed separate, medically necessary services during the same treatment session but many coders  (and carriers) have trouble selecting the appropriate modifier for certain services. The following modifier tips will help you determine when to use each of these commonly misapplied modifiers. Unbundling NCCI Edits? Try -59 According to CPT Codes, you should apply modifier -59 (Distinct procedural service) if your services fit into any of five situations: different sessions or encounters, different sites or organ systems, separate incisions/excisions, separate lesions, or separate injuries (or areas of injury).

These situations seem to describe a wide range of scenarios, and radiology practices often take these examples to mean that they should always append modifier -59 when they want to separate services. But many coders refer to -59 as the modifier of last resort. Because of this difference of opinion, some radiology practices arent sure when they can and cannot report modifier -59.

Its confusing because modifier -59 is the modifier of last resort, but its also a National Correct Coding Initiative (NCCI) unbundler, says Jeff Fulkerson, BA, CPC, CMC, certified coder for the department of radiology at The Emory Clinic in Atlanta. If youre trying to separate services that NCCI normally bundles together, you should use a modifier to separate them, but it wont always be -59, he says.
Determine Whether Other Modifiers Fit Before assigning modifier -59, you should first consider other modifiers, such as -78 (Return to the operating room for a related procedure during the postoperative period) or -79 (Unrelated procedure or service by the same physician during the postoperative period).

If, after considering the other options, -59 is still the most appropriate modifier, you should report it, Fulkerson says. He offers the following example: You perform a two-view chest x-ray at 9 a.m., but the patients condition worsens and her physician orders a one-view chest x-ray at 2 p.m. the same day.

In this case, modifiers -78 or -79 arent applicable, Fulkerson says. You should therefore report 71020 (Radiologic examination, chest, two views, frontal and lateral) for the morning x-ray, and 71010-59 (Radiologic examination, chest; single view, frontal) for the afternoon chest x-ray.

Remember that modifier -59 is only applicable if the NCCI edit carries a 1 modifier, says Tammy Boyer, CPC, coding and compliance administrator at Orthopedics and Sports Medicine in Burlington, Iowa.

Also remember that some services are truly supposed to be bundled together. And if a payer discovers that you append modifier -59 to separate all of the [...]

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