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3 Critical Mistakes Made When Reporting Modifier -59

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Here are three common but critical mistakes made by ASC coders when using modifier -59, according to Cristina Bentin, principal of Coding Compliance Management.

1. Incorrect utilization of -59 by ASCs to replace or mimic the -51 used by physicians. Physician practices apply the -51 modifier to multiple procedures after the primary procedure. While the -51 modifier is not an acceptable modifier for ASC use, some ASC carrier contracts/billing policies require it. Unless a facility is required to report the -51 modifier per written directive by its carrier, it should not be appending it to multiple procedures under normal circumstances. Furthermore, to automatically report the -59 modifier for all multiple procedures performed after the primary procedure in place of the -51 modifier is not only incorrect, but it is a red flag for future OIG and Medicare audits.

2. Under-utilization of -59: It's not taboo. When the Medicare edits (NCCI) correct coding modifier indicator (i.e., 1) allows a modifier to indicate a "separate" and "distinct" procedure, users may be able to capture the additional procedure provided operative documentation supports a "separate" and "distinct" procedure. Users must understand the meaning of the Medicare edits correct coding modifier indicators (0, 1 and 9) and when separate reporting is allowed.

3. Over-utilization of -59. Do not use -59 to bypass the edits when a procedure is truly integral to the main procedure. Remember, simply because the Medicare edits may allow for a modifier doesn't mean the procedure can always be reported with a -59 modifier just to bypass the edits. The procedure must clearly be "separate" and "distinct" from the more extensive procedure being performed during the same session.

Cristina Bentin can be reached at cristina@ccmpro.com. Learn more about Coding Compliance Management.

The information provided should be utilized for educational purposes only. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.


Read more ASC coding guidance from Cristina Bentin and Coding Compliance Management:

- Don't Forget to Bill for Shoulder Arthroscopic Limited Debridement

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Proper Coding for Use of Aqueous Shunts for Glaucoma

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3 Critical Knee Arthroscopy Coding Pitfalls Impacting an ASC's Bottom Line

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