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POLICYModifier -59 (distinct procedural service) should be used to indicate instances when distinct and separate multiple services, which are not normally reported together, are provided to a patient on the same date of service. Circumstances that may warrant the use of modifier -59 include:
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:
POLICY GUIDELINESThe coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.
POLICY HISTORY1/2003: Policy developed.
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."