Anesthesia Coding: Know How To Wield Modifier 59

By Author: Julia Rose
Total Articles: 89
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If you're an anesthesia coder, Modifier 59 might often catch you off-guard as this is one of the most misunderstood modifiers. So if your physician performs two medically necessary procedures during the same session, you'll certainly stand in good stead if you know the ins and outs of modifier 59.


If you want to wield these modifiers right and avoid problems and get your claims paid, the following tips will help you do so.


Know when to use this modifier. The OIG and many payers, including Medicare, continually review physicians' modifier 59 use. However, there are circumstances when you can, and should, use modifier 59. For example, you may use this modifier to identify procedures that are distinctly separate from another procedure provided by your physician on the same day. That apart, you can use modifier 59 when your physician tends to a patient during a different session, treats a different site or organ system, and other situations.


Remember that CCI limits the codes you can report separately. If you're not sure whether two procedures are subject to bundling ...
... edits, see the CCI edits. The CCI edits list two codes as mutually exclusive of one another or pair them as comprehensive and component. If you see reference to column 1 and Column 2 codes, CCI bundles the procedures and you need not report them together. You cannot automatically override a CCI edit with modifier 59 just because documentation supports a separate site, incision or patient meeting.


You should always prove necessity with documentation. Although modifier 59 is on the OIG watch list, there's less risk of overusing it if it is well-supported.


For more on anesthesia coding and the right ways to use modifier 59, the easiest way to go about is getting yourself audio recordings in CDs and MP3s which will run you through anesthesia conferences if you happen to miss it.

Gain knowledge about medical coding by attending proper medical coding conferences along with premier coding experts, CDs, tapes and transcripts of coding training information by specialty.