Modifier 59- Distinct procedural Service

April 13, 2021

What is Modifier 59?

Modifier 59 is used to identify a procedure that is distinct or independent from other non–E/M services that the provider performs on the same day.

 

How to use modifier 59:

Modifier 59 applies to procedures or services not typically reported together but are appropriate in specific situations. Modifier 59 tells the payer that the same provider does not ordinarily perform one procedure with another procedure for the same patient, on the same day. The procedures would not normally be reported together. In order to report Modifier 59, the provider’s documentation must support a:

  • Different encounter or session
  • Different surgery or procedure
  • Different organ system or body site
  • Separate incision or excision
  • Separate lesion
  • Separate injury

Do not append Modifier 59 to E/M services.

Did you know there are subsets of Modifier 59?

These are Modifiers known as “X” Modifiers. These Modifiers are used to better specify why the service provided was separate and distinct from the primary service reported. “X” Modifiers that better describe the distinct separate service should be used in place of Modifier 59 when applicable and when payers accept this Modifier.

Modifier XE

Modifier XE is defined as a separate encounter, a service that is distinct because it occurred during a separate encounter

Modifier XP

Modifier XP is defined as a separate practitioner, a service that is distinct because it was performed by a different practitioner

Modifier XS

Modifier XS is defined as a separate structure, a service that is distinct because it was performed on a separate organ/structure

Modifier XU

Modifier XU is defined as an unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service

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