Whenever one of your employees goes to the doctor or
hospital, all of the services rendered are documented. Then, a medical bill
coder reviews the services rendered, assigns the proper payment codes, and
creates a claim that is sent to your company to pay. Unfortunately, a lot of
mistakes can be made in the billing process. Bill coding can be a very
confusing task, and if the wrong codes and modifiers are used, you could end up
with a bill that’s inaccurate and much more expensive than it should be.
One of the most commonly misused modifiers in medical bill coding
is undoubtedly Modifier 59. Often confused with Modifier 51, Modifier 59 is
used to bill for multiple sessions or multiple, distinct procedures or
surgeries. When applied incorrectly, Modifier 59 can lead to exorbitant medical
bills and unfair charges for payers. That’s why it’s so important that you
understand this modifier fully so you can spot mistakes in your medical bills and
ensure they are corrected.
With that in mind, let’s take a look at what Modifier 59 is
and isn’t.
- Used for separate, distinct surgical procedures: Modifier 59 is to be used when multiple, distinct surgeries are performed. Distinct is the key word here. Independent is also a good description and a good way to determine if Modifier 59 is truly applicable. For example, if a surgeon has to perform the same surgery on distinct areas of the body (e.g. removing lesions from different sites on the body), thus requiring multiple incisions, Modifier 59 would be used, billing individually for each surgical procedure. Likewise, if the surgeon has to treat different injuries in different parts of the body, Modifier 59 would likely be used.
- Not to be used when multiple procedures are performed together in the same session: Here’s where Modifier 59 is commonly misused. When multiple procedures that are commonly performed together are carried out during the same session, Modifier 51 should be used instead to let the payer know that two or more procedures are being reported on the same day. Using Modifier 51 means that only the primary, most expensive surgery is billed at full rate, while the other procedures are bundled and billed at a 50 percent discount since they were performed during the same session.
Simply put, Modifier 59 is designed to address exemption from
NCCI (National Correct Coding Initiative) bundling edits. Unfortunately, providers
sometimes misuse Modifier 59 when, in fact, the services rendered should be bundled
together and billed at lower rates. Health care providers who overuse or
routinely use these modifiers incorrectly can actually get into trouble.
For this reason, it’s vital that businesses have a plan in
place to ensure all medical bills are audited properly. You simply cannot count
on the medical provider to bill you properly. By having a knowledgeable,
experienced partner reviewing every medical bill, mistakes like misused
modifiers can be caught, challenged and corrected, saving your company huge
sums of money in many cases.
Hey,
ReplyDeleteThanks for sharing such an amazing and informative post. Really enjoyed reading it. :)
Thanks
Apu
Medical Case Management
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ReplyDeletemedical coding placements
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