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modifier 59 clarification

Inessa Posted Tue 10th of May, 2016 11:16:24 AM
please clarify use of 59 mod. primary cpt listed first w/secondary cpt + 59? Is this always the scenario? 59 modifiers listed second? Where can I find extensive guidelines for modifiers?
SuperCoder Answered Wed 11th of May, 2016 03:10:17 AM
Hi, Correctly stated above. Use of Modifier 59 will be with the secondary code which has a conflict with the primary code(Only then the secondary code is separately payable). For more information you can refer to the link below: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf
Inessa Posted Thu 02nd of June, 2016 08:32:56 AM
Yes I have been sequencing the cpt code w/the 59 modifier second as you confirm. I am coding for ASC. MD completed a control of bleed and bx in 2 different areas of stomach. Control of bleed per supercoder gets a 59 mod when reported w/43239.... however reimbursement is higher for 43255. If this is listed second it will only pay at 50%... so is it acceptable to list the 43255 first w/59 mod then list 43239 second? In this case it is a Medicare pt. Is it ever acceptable to sequence the cpt code w/the 59 mod first? I have researched but have not found a clear answer.
SuperCoder Answered Fri 03rd of June, 2016 09:11:36 AM
Hi, 59 modifier is used with secondary code only. It is not acceptable for Medicare patient to append 59 modifier for Primary code.

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