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PAP514

CPT Modifier 59


Provider Administrative Policy

Section
Physician
Policy Date
November 2007
Status/Date
Revised/November 2008
Provider Type(s)
Physician  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

CPT Modifier 59

Under certain circumstances, a physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Use modifier 59 to identify those procedures/services not normally reported together, but appropriate under the circumstances. Examples include a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury or area of injury.

When another established modifier is appropriate, use it rather than modifier 59. Only use modifier 59 if a more descriptive modifier is unavailable and the use of modifier 59 best explains the circumstances. 

Blue Cross of Idaho may request medical documentation to support the use of Modifier 59 either during the prepayment medical review or post payment audit process.


Policy History

Date Action Reason
January 2010 Revised Information not applicable to this policy moved to PAP242
November 2008 Revised Language addition

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