Question

What should CMS encourage carriers to do moving forward with regards to the use of modifier 59?

Answer 1

What should CMS encourage carriers to do moving forward with regards to the use of modifier 59?

The Medicare National Correct Coding Initiative (NCCI) incorporates Procedure-to-Procedure (PTP) alters that characterize when two Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) codes ought not be accounted for together either taking all things together circumstances or by and large. For PTP alters that have a Correct Coding Modifier Pointer (CCMI) of "0," the codes ought to never be accounted for together by a similar supplier for a similar recipient on a similar date of administration. On the off chance that they are accounted for on a similar date of administration, the segment one code is qualified for installment and the section two code is denied.

For PTP alters that have a CCMI of "1," the codes might be accounted for together just in characterized conditions which are distinguished on the case by the utilization of particular NCCI-related modifiers. (Allude to the National Correct Coding Initiative Policy Manual for Medicare Administrations, Chapter 1, for general data about the NCCI program, PTP alters, CCMIs, what's more, NCCI-related modifiers.) One capacity of NCCI PTP alters is to avoid installment for codes that report covering administrations aside from in those occurrences where the administrations are "discrete and particular." Modifier 59 is an imperative NCCI-related modifier that is regularly utilized inaccurately.

The CPT Manual defines modifier 59 as follows:

"Particular Procedural Service: Under specific conditions, it might be important to demonstrate that a method or administration was particular or free from other non-E/M administrations performed around the same time. Modifier 59 is utilized to recognize methodology/administrations, other than E/M benefits, that are not ordinarily revealed together, yet are suitable considering the present situation. Documentation must help an alternate session, distinctive strategy or medical procedure, diverse site or organ framework, separate cut/extraction, separate sore, or separate damage (or territory of damage in broad wounds) not commonly experienced or performed around the same time by the same person. In any case, when another effectively settled modifier is proper, it ought to be utilized as opposed to modifier 59. Just if not any more enlightening modifier is accessible, and the utilization of modifier 59 best clarifies the conditions, should modifier 59 be utilized.