Health Information Management

Pay-per-view: CMS introduces four new subsets of modifier -59

APCs Insider, November 14, 2014

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Providers are going to have their work cut out for them come January 1, 2015, due to CMS releasing four new HCPCS modifiers to define subsets of modifier -59 (distinct procedural service). The impetus behind this is clear--CMS believes this modifier is being abused. Specifically, CMS believes providers are using modifier -59 to bypass NCCI edits when they shouldn't.
 
CMS' statement in Transmittal 1422 that the use of this modifier is "associated with considerable abuse" is one clue into the agency's motivation for creating the new modifiers.
 
Continue reading CMS introduces four new subsets of modifier -59 on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the November issue.



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