Health Information Management

Tip: Append modifier -59 to correct code

APCs Insider, September 3, 2010

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One myth around usage of modifier -59 is that you can append it to either code and it will override National Correct Coding Initiative (NCCI) edits. As a matter of fact, you need to pay attention to which code you modify. Each NCCI edit table contains edits, which are pairs of codes that in general should not be reported together. 

If a provider reports two codes of an edit pair, the payer will deny the column 2 code and pay the column 1 code. That’s true regardless of whether you’re looking at the column 1/column 2 or mutually exclusive edits.

When it’s valid, attach modifier -59 to the applicable column 2 procedure rather than the column 1 code.

This tip is adapted from “Five myths about correct use of modifier -59 busted” in the September issue of Briefings on APCs.



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