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But at the same time, it is a two-edged sword, the modifier 59 is exceptionally dangerous when used incorrectly and care is not applied, just like a doctor would find for their patient when using prednisone. Modifier 59 is the universal unbundling modifier.
Modifier 59 is an important NCCI PTP-associated modifier that physicians and providers often use incorrectly. This fact sheet will help you use this modifier correctly. Definition of Modifiers 59, XE, XP, XS, & XU
Modifier 59 - What you need to know. Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-evaluation and management (E/M) services performed on the same day.
Modifier 59 Distinct procedural service is an “unbundling modifier.” When properly applied , it allows you to separately report—and to be reimbursed for—two or more procedures that normally would not be billed or paid independently during the same provider/patient encounter.
How to use Modifier 59. Follow the path for when and how you can separately bill NCCI-bundled codes.
This fact sheet educates physicians and other providers on proper use of modifiers 59 and –X{EPSU} and gives information on: Definition of modifiers 59, XE, XP, XS, and XU. Appropriate and inappropriate use of these modifiers. Examples of appropriate and inappropriate use.
Modifier 59 is referred to by CMS as the modifier of last resort. It is often used when modifier 51 is the more accurate modifier. This quick reference sheet explains when, why and how to use it.
Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.
Modifier 59 is used to identify procedures/services, other than Evaluation/Management services, that are not normally reported together, but are appropriate under the circumstances. XE, XS, XP, and XU are valid modifiers and provide greater reporting specificity.
CPT ® modifier 59 is an important National Correct Coding Initiative (NCCI) associated modifier that is often used incorrectly and it should only be used if no more descriptive modifier is available or when its use best explains the circumstances.