Corporate Compliance

Tip: Ensure that your staff is properly reporting modifier -59

Compliance Monitor, July 4, 2007

Do not use modifier -59 and other National Correct Coding Initiative (NCCI)-associated modifiers to bypass an NCCI edit unless documentation in the medical records meets the proper criteria for use of the modifier.

One of the common misuses of modifier -59 is when when coders report it in conjunction with two separate procedures/surgeries that providers perform at the same anatomic site and during the same patient encounter. From an NCCI perspective, the definition of different anatomic sited includes different organs or different lesions in the same organ, MLN Matters article SE0715 states. It does not include treatment of contiguous structures of the same organ.

Note that modifier -59 does not require different diagnosis codes for each HCPCS/CPT coded procedure/surgery to indicate different procedures/surgeries. Different diagnoses are not adequate criteria to use modifier -59.

For more information on modifier -59, visit the CMS Web site.

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