Health Information Management

Tip: Using modifier -59 to bypass drug administration edits

APCs Insider, July 24, 2015

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Use modifier -59 (distinct procedural service) only when appropriate to bypass medically unlikely edits and NCCI edits. Coding professionals can append modifier -59 to Column 2 CPT® codes in the NCCI edits for hydration, antiemetic, or other non-chemotherapy drug administration before, after, or at different patient encounters than the chemotherapy.
Just because an edit appears that would allow modifier -59 does not mean coding professionals should automatically add it. The converse is also true: Just because an edit doesn't surface does not automatically mean that what coding professionals are reporting is allowed.
Coding professionals should review drug administration cases carefully to ensure that appropriate coding and charging is occurring, and that it is all supported by documentation.
This tip is adapted from “Use caution when applying modifier -59 for drug administration services" in the July issue of Briefings on APCs.

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