Modifier 59: Article - Reminder

Cahaba Government Benefit Administrators®, LLC -MAC for Jurisdiction 10, which includes Alabama, Georgia and Tennessee

Modifier 59 is an NCCI-associated modifier that is often used incorrectly. This modifier should be used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury not ordinarily encountered or performed on the same day by the same physician. Modifier 59 was established to permit claims of this nature to bypass correct coding edits. Medical records should support the filing of this modifier.

When reporting repeat procedures (the same procedure code), on the same day, for the same patient, modifier 76 should be used, not modifier 59.

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