--- title: Proper Use of Modifier 59 Can Increase Revenue for Medical Practices description: Medical Billing Company Explains Proper Use of Modifier 59 to Increase Medical Practice Revenue image: https://www.mbrbilling.com/hs-fs/file-16617108-jpg/images/modifier59-resized-600.jpg --- [![](https://www.mbrbilling.com/hs-fs/hubfs/MBR-Images/logo.png?width=340&name=logo.png)](https://www.mbrbilling.com/) - [Home](https://www.mbrbilling.com/) - [Client Login](http://clientlogin.mbrbilling.com/) - [Contact Us](https://www.mbrbilling.com/contact-us) SEARCH # Medical Billing Blog # Proper Use of Modifier 59 Can Increase Revenue for Medical Practices Posted by [Ali Ziehm](https://www.mbrbilling.com/blog/author/ali-ziehm) on Thu, Jun, 07, 2012 @ 13:06 PM - [Tweet](https://twitter.com/share) ![Modifier 59 Can Increase Revenue for Physicians](https://www.mbrbilling.com/hs-fs/file-16617108-jpg/images/modifier59-resized-600.jpg?width=327&height=282&name=modifier59-resized-600.jpg)**By Heather Lakner, CPC** -- Modifier 59 can be used in appropriate circumstances to unbundle codes to make them separately payable under Medicare guidelines.  This can mean an increase in revenue for medical practices in circumstances when this modifier is appended correctly, with proper documentation to support its use.  Unfortunately, Modifier 59 is often used incorrectly.  Many billers will append it to a service to override an edit, but this can set up their medical practice for a substantial audit risk if it is applied incorrectly, or if cirumstances in the patient’s medical record do not clearly indicate that its use is appropriate.   Modifier 59 is the Level 1 CPT Code used to indicate that a distinct procedural service was performed, and should generally be applied to the secondary code in a code pair, but should not be appended to Evaluation & Management codes.  In the 2012 CPT book, the guidelines for use of Modifier 59 state that “Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.”  Documentation must support use of this modifier by indicating that two procedures were performed under any of the following circumstances: - on different anatomical sites, - using separate incision sites, - on two separate organ systems, - on two separate lesions, - on two separate injuries, or areas of injury in the case of extensive injury, or - one procedure was used as a diagnostic tool to determine that the second procedure should be subsequently performed The CPT Manual also states that modifier 59 should be used only when there is no other modifier to describe the service more appropriately.  Furthermore, there are instances when modifier 59 cannot be appended to bundled codes even if it would seem to be indicated by documentation in the record.  This is true of codes that are considered to be so integrally part of each other that they cannot be billed separately.  These codes generally get edits that include the verbage, “may not be unbundled using any modifier.”  In these cases, modifier 59 cannot be used to override the edit. The biggest error in using modifier 59 comes from its definition that says “different procedure or surgery.”  For example, if a physician completes a destruction of a benign or premalignant lesion, CPT code 17000, and also performs a biopsy on a separate lesion (different site), CPT code 11100, modifier 59 is perfectly appropriate.  On the other hand, if a surgeon has to perform a laparotomy for exploration, CPT Code 47015, and finds that the appendix requires excision, CPT Code 44955, it is not appropriate to append modifier 59, because the laparotomy would be considered an integral part of the appendectomy and other procedures that are performed through that incision at that site on that date. The Office of Inspector General (OIG) is keeping a close watch on use of modifier 59, and has been for years, because there is a high incidence of unscrupulous use of modifier 59 to unbundle codes that should not be separately payable.  In fact, a paper released by the OIG in 2005 highlighted an investigation they performed to determine the extent of the incidence of use of modifier 59 to bypass Medicare’s National Correct Coding Initiative Edits.  The 27-page paper reported on the most frequently inappropriately unbundled codes, and issued recommendations to the Centers for Medicare and Medicaid Services and other carriers to continue to perform pre- and post-payment audits of the use of modifier 59.  They reported that, in 2003, 40 percent of code pairs billed with modifier 59 did not meet the program requirements, thus making it inappropriate as an applied modifier.  Ultimately, providers should make sure they document the medical necessity of performing both procedures, and include details showing how the use of the modifier is indicated by the guidelines.  In the case of modifier 59, documentation and appropriate use are the provider’s best defense against an audit, and may boost the bottom line when used correctly. ### Subscribe via Email [![](https://www.mbrbilling.com/hs-fs/file-16642138-png/images/bg/facebook.png)](https://www.facebook.com/MedBillResources) [![](https://www.mbrbilling.com/hs-fs/file-16650079-png/images/bg/twitter.png)](https://twitter.com/#!/MedBillResource) [![](https://www.mbrbilling.com/hs-fs/file-16643229-png/images/bg/linkedin.png)](http://www.linkedin.com/company/medical-billing-resources) [![](https://www.mbrbilling.com/hs-fs/file-16646680-png/images/bg/rss.png)](https://www.mbrbilling.com/CMS/UI/Modules/BizBlogger/rss.aspx?tabid=484940&moduleid=1043750&maxcount=25&u=107101&t=BBE4D262E126601B3B04C3F46C38B13F) [![New Call-to-Action](https://no-cache.hubspot.com/cta/default/119723/112e1d48-db0d-4713-be81-8744e7438136.png)](https://cta-redirect.hubspot.com/cta/redirect/119723/112e1d48-db0d-4713-be81-8744e7438136) [![Click me](https://no-cache.hubspot.com/cta/default/119723/73857c0b-bb42-4989-9f2b-6f01b79dda8d.png)](https://cta-redirect.hubspot.com/cta/redirect/119723/73857c0b-bb42-4989-9f2b-6f01b79dda8d) [![worksheet](https://no-cache.hubspot.com/cta/default/119723/e4db838f-b08e-4fb6-bce4-c965b078dce1.png)](https://cta-redirect.hubspot.com/cta/redirect/119723/e4db838f-b08e-4fb6-bce4-c965b078dce1)     ### Latest Posts ### Browse by Tag - 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