Clarification on Modifier 59

Medicare policy limits the use of modifier 59. Medicare’s long-standing policy is that modifier 59 should be reported only when procedures are performed on different anatomic sites or different patient sessions on the same day. The modifier should not be used as means to simply bypass an edit nor is it used simply because the two CPT code descriptors are different. It should only be appended to identify clearly independent services that represent significant departures from the usual situations described by a CCI edit. The medical record must support the distinct nature of the services. It is not necessary to have different diagnosis codes for the two procedures, but that is often the case. Care should be taken to ensure that the most accurate ICD code is being provided for each service.