Can you use modifier 58 and 59 together?
Asked by: Prof. Fay Hilpert II | Last update: November 5, 2025Score: 4.5/5 (17 votes)
Can modifier 58 and 59 be billed together?
Shouldn't they be billed with modifier 58? No, because although the “same day” could technically be called part of “the post-operative period,” the definition of modifier 59 clearly focuses on “the same day.” That's much more specific than “post-operative.” Further, this is a non-E/M service.
Can you use two modifiers on one CPT code?
CPT modifiers are added to the end of a CPT code with a hyphen. In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second.
When should you use modifier 58?
Modifier 58 is defined as a staged or related procedure performed during the postoperative period of the first procedure by the same physician. A new postoperative period begins when the staged procedure is billed.
Under what circumstances would modifier 59 not be appropriate?
If you performed 2 procedures on different sides of the body, you may report them with modifiers LT and RT as appropriate. However, modifiers 59, XE, XS, XP, XU are inappropriate if the basis for their use is that the narrative description of the 2 codes is different.
Medical Coding Modifiers 58 and 59 - CEU on Demand Class
What is the modifier 59 rule?
For the NCCI, the primary purpose of CPT® modifier 59 is to indicate that two or more procedures are performed at different anatomic sites or during different patient encounters. It should only be used if no other modifier more appropriately describes the relationships of the two or more procedure codes.
Which scenario qualifies for modifier 58?
In surgical situations when a subsequent procedure takes place within the global period of the original procedure, and/or because the physician anticipated a planned (or staged) procedure, modifier 58 comes into play.
Does modifier 59 go on primary or secondary?
It should only be used if no other modifier more appropriately describes the relationship of the two or more procedure codes.” This is different from the way CPT defines modifier 59. In other words, a physician can use modifier 59 to bill the secondary, additional, or lesser procedure in an NCCI edit combination.
What is the Medicare Code 58?
Denial code 58 is used when the payer determines that the treatment or service was provided in a location that is considered inappropriate or invalid according to their guidelines.
Which modifier should go first?
Informational or statistical modifiers (e.g., any modifier not classified as a payment modifier) should be listed after the payment modifier. If multiple informational/statistical modifiers apply, you may list them in any order (as long as they are listed after payment modifiers).
What are the two types of modifiers that can be combined?
Modifiers give additional information about nouns, pronouns, verbs, and themselves to make those things more definite. There are two types of modifiers: adjectives and adverbs.
How to use modifier 59 correctly?
Modifier 59 should not be used (as it is unnecessary) if the narrative description of the two codes is different. Modifier 59 is used appropriately for two services described by timed codes provided during the same encounter only when they are performed sequentially.
Can medicare patients see two doctors in one day?
The para states that as for all other E/M services except where expressly noted, the Medicare Administrative Contractors (MACs) may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician ...
How to tell if CPT codes are bundled?
This depends on medical coding rules. Bundling occurs when procedures or services with unique CPT or HCPCS Level II codes are billed together under one code. Unbundling is when two or more codes that are normally part of a single procedure can be billed separately.
What CPT codes are changing for 2024?
Several Category III codes will be converted to Category I codes in the Current Procedural Termi- nology (CPT®) 2024 code set, these include: dorsal sacroiliac (SI) arthrodesis; coronary fractional flow reserve (FFR) with computerized tomography (CT); coronary intravascular lithotripsy (IVL) interventions; ...
How many modifiers can be used for one procedure?
If appropriate, more than one modifier may be used with a single procedure code; however, are not applicable for every category of the CPT codes. Some modifiers can only be used with a particular category and some are not compatible with others.
When should modifier 58 be used?
Modifier 58. Modifier 58 Staged or related procedure or service by the same physician during the postoperative period may be necessary to indicate the performance of a procedure during the postoperative period was: Planned prospectively at the time of the original procedure, or “staged;”
What is the reason code 59 for Medicare?
Medicare contractors will use the following Claim Adjustment Reason Code (CARC) on the remittance advice for service lines for which they have applied the Multiple Procedure Payment Reduction (MPPR): Code 59: Processed based on multiple or concurrent procedure rules.
What is procedure code 58?
Lay Term. Append modifier 58 to a procedure occurring during the postoperative period when the procedure is planned or staged.
When should modifier 59 be appended to a claim?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
Can modifier 59 be used on labs?
Modifier 59 (distinct) and 91 (repeat) are valid modifiers for most laboratory services and should be used when multiple laboratory services described by a single code are provided to a patient on one day by the same provider.
How are multiple modifiers sequenced?
The proper sequencing order for modifiers is as follows: 1) pricing, 2) payment, and 3) location. Location modifier is always reported last in any coding scenario.
What is modifier 59 used for?
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.
Can modifier 50 and 59 be used together?
If only one procedure was performed bilaterally, modifier -59 should not be used on the charge with modifier -50.
Which type of modifier should be listed first if applicable?
Pricing Modifiers
A pricing modifier is a medical coding modifier that causes a pricing change for the code reported. The Multi-Carrier System (MCS) that Medicare uses for claims processing requires pricing modifiers to be in the first modifier position, before any informational modifiers.