Can I use Modifier 59 for Office Visit 99213, 99214?

Modifier 59

2015_Medicare_Modifier_59_Changes_with_4_New_ModifiersAsk a Question:  An established patient came in to our office for her Well-Woman Exam or Preventive Exam but also presented with a back pain after hurting her back bringing her Christmas Tree and Decors up from her basement.Can I use modifier 59 for Office Visit 99213 or problem-sick visit for her back pain encounter with the provider? or Can I use modifier 59 for Preventive Visit code of which she was originally scheduled to be seen that day?

From Blog Subscriber.

 Per CPT Guideline, part of it reads – “Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see Modifier 25”

So the ANSWER is – NO. 

You do not use or append modifier 59 to an E/M (Evaluation and Management) code! This modifier is not applicable with your E/M codes! You only append this to your procedure codes describing a Distinct Procedural Service.

Use instead the Modifier 25 – (to identify a significant, separately identifiable evaluation and management service  performed on the same day as another procedure or service by the same  provider); or Modifier 24 – (to identify an unrelated E/M services during the post-operative / global period beginning the day after a procedure, when the E/M is performed by the same physician)

References: CPT Code Book (Modifier Section), CMS Guidelines and NCCI Edits about Modifier 59

Question asked: Can I use Modifier 59 for Office Visit 99213

Answer: NO.

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modifier 59 with office visit

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Author: Pinky Maniri

Ms. Pinky, as she is fondly called - is a Reputable Professional Consultant and Expert in Practice Administration, Medical Billing, Coding, Health Information Technology, Insurance Credentialing and Compliance for Physician Offices. Well-educated with a Degree in Computer Systems Engineering and a background in Clinical Nursing and Small Business Management. Her professional mission is to make sure her clients/physicians maximize reimbursement while they remain compliant with the current rules, changes, guidelines and policies. Read More About Ms. Pinky here and See what Other's say about her Expertise Testimonials

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