Quick Answer: What Is The 59 Modifier?

What is the modifier in a sentence?

A modifier is a word, phrase, or clause that modifies—that is, gives information about—another word in the same sentence.

For example, in the following sentence, the word “burger” is modified by the word “vegetarian”: Example: I’m going to the Saturn Café for a vegetarian burger..

What is the difference between modifier 25 and 59?

Modifier 25 may be appended only to a code found in the E/M section of the CPT manual. Modifier 59 is used to indicate a distinct procedural service.

What is a 51 modifier?

Modifier 51 Multiple Procedures: use Modifier 51 to indicate that multiple procedures (other than E/M) were performed at the same session by the same provider. Use modifier 51 on the second and subsequent operative procedures when the procedures are ranked in RVU order.

What does Xe modifier mean?

XE Separate EncounterModifier XE Separate Encounter, A Service That Is Distinct Because It Occurred During A. Separate Encounter. Modifier XS Separate Structure, A Service That Is Distinct Because It Was Performed On A. Separate Organ/Structure.

Can modifier 59 be used with unlisted CPT code?

is it appropriate to put modifier 59 on an unlisted code? Probably not, unless you’ve already received a bundling/inclusive denial. It’s difficult to say whether or not a service is ‘not ordinarily encountered or performed on the same day’ as another procedure, without knowing exactly what the 2 procedures are.

What is modifier 77 used for?

CPT modifier 77 is used to report a repeat procedure by another physician. This modifier may be submitted with EKG interpretations or X-rays that require a second interpretation by another physician.

What does a 25 modifier mean?

The Current Procedural Terminology (CPT-4) manual gives the definition of modifier -25 as. follows: (From CPT-4, copyright American Medical Association) “Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service.”

Do add on codes need modifier 59?

“Generally speaking, we do not need to report modifier -59 on add-on codes.”

What is modifier 55 used for?

Postoperative Management Only. When a physician or other qualified health care professional performs the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by appending this modifier to the surgical procedure.

What is the difference between 51 and 59 modifier?

While modifier 51 and 59 both apply to additional procedures performed on the same date of service as the primary procedure, modifier 51 differs from modifier 59 in that it applies to procedures that may be more commonly expected to be performed during the same session.

Where do you put modifier 59?

Modifier 59 should be used to distinguish a different session or patient encounter, or a different procedure or surgery, or a different anatomical site, or a separate injury. It should also be used when an intravenous (IV) protocol calls for two separate IV sites.

What is the 58 modifier?

Modifier 58 is defined as a staged or related procedure performed during the postoperative period of the first procedure by the same physician. A new postoperative period begins when the staged procedure is billed.

What is the 26 modifier?

The CPT modifier 26 is used to indicate the professional component of the service being billed was “interpretation only,” and it is most commonly submitted with diagnostic tests, including radiological procedures. When using the 26 modifier, you must enter it in the first modifier field on your claim.

What is a 50 modifier?

Modifier 50 is used to report bilateral procedures that are performed during the same operative session by the same physician in either separate operative areas (e.g. hands, feet, legs, arms, ears), or one (same) operative area (e.g. nose, eyes, breasts).

Which modifier goes first 26 or 59?

guidelines: order of modifiers If you have two pricing modifiers, the most common scenario is likely to involve 26 and another modifier. Always add 26 before any other modifier. If you have two payment modifiers, a common one is 51 and 59, enter 59 in the first position. If 51 and 78, enter 78 in the first position.

What is a 78 modifier?

Modifier 78 is used to report the unplanned return to the operating/procedure room by the same physician following an initial procedure for a related procedure during the postoperative period.

What is the 59 modifier for CPT codes?

Distinct Procedural ServiceThe definition of the 59 modifier per the CPT manual is as follows: Modifier 59: “Distinct Procedural Service” – Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day.

What is modifier 57 used for?

Modifier 57 Decision for Surgery: add Modifier 57 to the appropriate level of E/M service provided on the day before or day of surgery, in which the initial decision is made to perform major surgery. Major surgery includes all surgical procedures assigned a 90-day global surgery period.

What is a 58 modifier used for?

Staged or related procedure or service by the same physician during the postoperative period. Submit CPT modifier 58 to indicate that the performance of a procedure or service during the postoperative period was either: Planned prospectively at the time of the original procedure (staged);

What is a 56 modifier?

Modifier 56 indicates that a physician or qualified health care professional other than the surgeon performed the preoperative care and evaluation prior to surgery.

What is a 79 modifier used for?

Modifier 79 is appended to a procedure code to indicate that the service is an unrelated procedure that was performed by the same physician during a post-operative period.