What is the modifier 59 used for?
Asked by: Helga Lang | Last update: May 27, 2025Score: 4.9/5 (50 votes)
When should a 59 modifier be used?
For example, Modifier 59 should be used when coding for a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion (noncontiguous lesions in different anatomic regions of the same organ), or separate injury.
What is the use of 59 modifier with example?
For example, you may report modifier 59 if you perform 1 service during the initial 15 minutes of therapy and you perform the other service during the second 15 minutes of therapy.
What is the difference between modifier 25 and modifier 59?
Modifier -59, “Distinct Procedural Service,” is similar to modifier -25, but it's applicable to procedural, rather than E/M, services.
What is the difference between modifier 59 and 78?
Modifier 59 refers to a non-E/M service performed on the same day. In comparison, modifiers 79, 78, and 58 refer to unrelated procedures or E/M services performed post-op. However, the point of confusion is usually regarding modifier 79.
Modifer 51 and 59 in Medical Coding -- What's the Difference and which one should you use??
What is modifier 78 used for?
Modifier 78 is used to report the unplanned return to the operating/procedure room by the same physician following an initial procedure for a related procedure during the postoperative period.
What is the modifier 59 on a claim?
MODIFIER -59 IS USED TO IDENTIFY PROCEDURES/SERVICES THAT ARE NOT NORMALLY REPORTED TOGETHER, BUT ARE APPROPRIATE UNDER THE CIRCUMSTANCES.
What is a 79 modifier used for?
Modifier 79 is used to indicate an unrelated procedure performed by the same physician during the postoperative period of the original surgery. When the procedure is related to the original surgery or is a staged (anticipated) surgery, it falls under the global period and should not use Modifier 79.
What does modifier 50 do?
Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).
When not to use modifier 25?
Modifier 25 should not be used when: ❌ The sole purpose of the encounter is for the procedure (e.g., lesion removal), and there is no documented medical necessity for a separate E/M service.
Does modifier 59 reduce reimbursement?
The 59 modifier allows for reduction because each procedure contains the reimbursement for the prep as well as the procedure. The 59 says this procedure is performed in the same session, there for the prep is then carved out of the reimbursement or as we say discounted.
Which modifier goes first?
In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second. The distinction between the two is simple: you always want to list the modifiers that most directly affect the reimbursement process first. There's a straightforward reason to this, too.
What is modifier 59 examples?
59 Modifier Examples
An example of appropriate use of the 59 modifier might be if a physical therapist performed both 97140 (manual therapy) and 97530 (therapeutic activity) in the same visit. Normally these procedures are considered inclusive.
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.
Can you bill modifier 50 and 59 together?
If only one procedure was performed bilaterally, modifier -59 should not be used on the charge with modifier -50.
When to use modifier 90?
Independent laboratories shall use modifier 90 to identify all referred laboratory services. A claim for a referred laboratory service that does not contain the modifier 90 is returned as unprocessable if the claim can otherwise be identified as being for a referred service.
What is modifier 80 used for?
Current Procedural Terminology (CPT®) Modifier 80 - CPT Modifier 80 represents assistant at surgery by another physician. This assistant at surgery is providing full assistance to the primary surgeon.
What is 57 modifier?
CPT modifier 57 may be used to report the decision for surgery for certain codes. This modifier may be used to indicate that an evaluation and management (E/M) service performed on the same day or the day before a major surgery (090 global days) by the surgeon resulted in the decision to perform the procedure.
What is modifier 55?
Modifier 55
Postoperative Management Only. When a physician or other qualified health care professional performs the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by appending this modifier to the surgical procedure.
What is a 52 modifier?
Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.
What is modifier 62?
Definitions. Modifier 62. Current Procedural Terminology (CPT®) - modifier 62 describes when two surgeons of the same or different specialties work together as primary surgeons performing distinct part(s) of a surgical procedure. Co-Surgeon Indicators.
What is 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.
When should I use modifier 59?
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.
What is modifier 56?
Modifier 56 is used for preoperative management only when a qualified health care professional performed the preoperative care and evaluation and another performed the surgical procedure.