-59 Modifier
CPT has some very specific rules for the use of modifier -59. This modifier is considered the modifier of last resort. You will typically use this modifier when no other modifier seems to fit.
Medicare and CPT have the same definition for this modifier. It is used for services that are not normally reported together but are appropriate under the circumstances. These circumstances may represent:
- different sessions or patient encounters
- different procedure or surgery
- different site or organ system
- separate incision or excision
- separate lesion
- separate injury
- services not normally encountered or performed on the same date by the same physician
-59 is an important modifier associated with the National Correct Coding Initiative (NCCI). This modifier is often used incorrectly with the NCCI edits. For NCCI, its primary purpose is to indicate that two or more procedures are performed at different anatomic sites or different patient encounters. It is also appropriate to use this modifier when two procedure codes may not be reported at the same time except under special circumstances. It is inappropriate to use the -59 modifier to bypass the NCCI edits unless the special circumstance exists. The documented note should justify that the special circumstance exists and the criteria for this use of this modifier is met.
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WHICH MODIFIER DO I USE WHEN THE DOCTOR HAS PERFORMED PAP FOR A PATIENT AND TREATED FOR OTHER ISSUES IN THE SAME DAY?