Health Information Management

Tip: Experts weigh in on proper use of modifier -59

APCs Insider, October 4, 2013

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With all of the exceptions and restrictions surrounding modifier -59 (distinct procedural service), coders may think they have few opportunities to actually use it.  

For instance, a patient comes in twice a day for antibiotic therapy and is being charged for two initial infusion fees. Both modifier -59 and -76 seem applicable, but in this case, append modifier -59.

In this case, the patient goes home between visits. When the patient comes in for the second infusion, coders should assign another initial infusion code because it is a new visit. Coders would need to append modifier -59 to the second initial infusion code to show that it is a new encounter.

This tip is adapted from “Experts weigh in on proper use of modifier -59” in the October issue ofBriefings on APCs.



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