Using modifier 59 to sidestep bundling denials certainly boosts your reimbursement, but it has also driven payers to add these claims to their active watch lists.
Insurers are just waiting for you to make a mistake — and there are plenty of opportunities to do so. Muddying the waters is the fact that you can also choose the X modifiers when your provider performs more than one procedure—and you must wade through reams of NCCI edits before pinpointing the right option. Append modifier 59 in error, and you’ll not only face denied claims, but you’ll also expose your practice to the fines and penalties that follow.
How steep are the penalties? Think $10,000 PER line item that you submit on your claim. That’s enough to sink any medical practice, no matter how well its other operations run. Your best defense is to shore up your modifier 59 use immediately. That means using it exclusively when it’s the ONLY modifier left after ruling out all others, mastering the NCCI pairs, and knowing which line item gets modifier 59 and which doesn’t.
If this sounds like a lot to master, that’s because it is. But you don’t have to go it alone.
Nationally recognized physician, coder, and healthcare consultant Dreama Sloan-Kelly, MD, CCS, CPC, is here to help. During her one-hour online training session, Dr. Sloan-Kelly will walk you through the nuances of correctly utilizing modifier 59. She’ll help you better identify distinct procedural services to help you get reimbursed more of what you are due.
Here are just a few of the modifier 59 strategies Dr. Sloan-Kelly will share with you during her exclusive online training:
- Differentiate modifier 51 and the X modifiers from modifier 59
- Identify how insurers define “distinct” to cut claim denials
- Audit-proof your documentation terminology to justify modifier 59 usage
- Slash denials, more easily incorporate 2023 NCCI edits into your coding practices
- Cut confusion by mastering the difference between modifiers 59 and 25
- Strategically apply modifiers in the correct order to maximize pay up
- Determine which services are bundled into the main procedure and which are separate
- Pin down how to overturn incorrectly denied modifier 59 claims
- Improve acceptance odds by mastering when to use the “modifier of last resort”
- And much, much more…
IMPORTANT: Modifier 59 misuse is so much more than a Medicare issue. Nearly every payer is looking for ways to save money, and one key method is to boost denials for modifier 59 claims which typically reimburse at a higher rate in higher frequencies. Payment reviews of this modifier are happening across the board, and you don’t want to be a statistic.
Don’t risk seeing your claims denied—or worse, being accused of modifier fraud—because you didn’t take the time to master this complex modifier. Sign up today for Dr. Sloan-Kelly’s exclusive training so you can keep your claims processing smoothly and successfully. Don’t wait. Sign-up today!
Dreama has over 14 years of experience in the medical field. A graduate of Wellesley College and Tufts University School of Medicine she has a varied background including clinical, billing, and coding. As CEO of Dr. Sloan-Kelly Consulting, Dreama speaks at various seminars, imparting her knowledge in an upbeat, matter of fact, manner.
Her goal is to provide attendees with only pertinent information to minimize the nonsense, and make sure everyone has fun at the same time. Dreama works with practices one on one, through coding consulting. She offers in-services seminars that can be held on or off-site. Dreama has learned in most seminars you spend a whole day only getting 20% of what you need, and 80% you leave – she has made it her goal to carve out the 20% that you need and giving you the take home message that will help you and your practice.
