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POLICY

• separate sessions or patient encounters
• different procedures or surgeries
• different sites or organ systems
• separate lesions
• separate injuries

Modifier -59 also assists in the reporting of codes designated as "separate procedures." The separate procedure designation indicates that a certain procedure or service may be performed independently or is unrelated or distinct from other procedure(s)/service(s) provided at that time. When a procedure or service that is designated as a separate procedure is carried out independently or considered unrelated or distinct from other procedures or services provided at that time, then it is appropriate to report the procedure separately with modifier -59 appended. When a "separate procedure" is carried out as an integral component of another procedure or service performed at the same time, the procedure should not be reported in addition to the procedure of which it is considered an integral component. At times, medical records may be requested for claims appended with modifier -59.

Below are just a few examples of when it is appropriate to use modifier -59:

• To identify the catheterizations of vessels in different vascular families as distinct services.

• To indicate that the biopsy of a lesion was of a different lesion than the one removed.

• To indicate a second thrombectomy that is performed on a different anatomic vessel.

• To indicate the performance of instrumentation at a separately identifiable site.

• To indicate a second sentinel node is excised from a different lymphatic chain through a separate incision at the same operative session.

• To indicate shaving of articular cartilage (29877) when performed in separate compartments of the knee at the same operative session as another arthroscopy procedure that includes meniscal shaving (e.g., 29880, 29881)

• To indicate the performance of an escharotomy for incision/release of a burn eschar (scab) at a different anatomic site.- To indicate treatment provided at different sessions on the same date of service.

• To indicate when the same procedure is performed on a different digit on the same hand or foot.

POLICY EXCEPTIONS

POLICY GUIDELINES

POLICY HISTORY

9/17/2007: Example of when to use modifier -59 (6th bullet) revised to clarify intent of statement.

6/25/2008: Policy revised to add statement "At times, medical records may be requested when modifier -59 is appended."

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