What does modifier 59 indicate?

Modifier 59 is used to indicate a distinct procedural service. This modifier is applied when a procedure or service is performed that is separate and distinct from another procedure or service performed on the same day. It allows healthcare providers to report services that may typically be considered bundled in order to signify that the services provided are not part of the main procedure and should be reimbursed separately.

For example, if a patient underwent two different surgical procedures on the same day, and they were performed at different anatomical sites or involved different areas of the body, modifier 59 would clarify that one of the procedures is indeed distinct from the other. It is important to note that simply using this modifier does not guarantee reimbursement; the services must still be medically necessary and appropriately documented.

Using modifier 59 correctly helps in compliance with billing regulations and ensures that providers receive appropriate payment for genuine separate services rendered. This further highlights its significance in coding and billing practices within healthcare.