Modifier “r;-59”

Under certain circumstances, a physician may need to indicate that a procedure or service was distinct or independent from other services, and modifier “r;-59” may be appropriate depending on the circumstances. Modifier “r;-59” is used to identify procedures / services that are not normally reported together, and this include the following procedures/services that are not ordinarily encountered or performed on the same day by the same physician:

A different

• Session or patient encounter
• Procedure or surgery
• Site or organ system

A separate

• Incision/excision
• Lesion
• Injury (or area of injury in extensive injuries)

For the NCCI, the primary purpose of modifier “r;-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.

Modifier “r;-59” and other NCCI-associated modifiers should NOT be used to bypass an NCCI edit unless the proper criteria for use of the modifier is met. Documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier used.

Use of modifier “r;-59” to indicate different procedures / surgeries does not require a different diagnosis for each HCPCS/CPT coded procedure/surgery. Additionally, different diagnoses are not adequate criteria for use of modifier “r;-59”.

From an NCCI perspective, the definition of different anatomic sites includes different organs or different lesions in the same organ. However, it does not include treatment of contiguous structures of the same organ. For example, treatment of the nail, nail bed, and adjacent soft tissue constitutes a single anatomic site. Treatment of posterior segment structures in the eye constitute a single anatomic site.