Modifier 59: Misused and Misunderstood

Consistent misuse and abuse of modifier 59 has put it on the Office of the Inspector General’s active radar. Meaning they are just waiting for you to slip up.

To make matters worse, modifier 59 sub-modifiers (XE, XS, XP, XU) and varying carrier guidelines, make it even more difficult to get right. In fact, CMS Transmittal 1422 projects error rates for modifier 59 at $320 million in physician claims.

Considering the size of these projected overpayments, you can rest assured that CMS is sitting up and paying close attention and will be working hard to recoup this reimbursement.

So, what does this mean to you? If you’re found to be using modifier 59 erroneously, the reimbursements you received for those services will be taken back by CMS. And if that leads to a full-scale audit of your modifier 59 claims, you could also have to pay $10,000 for EACH time you submit it incorrectly on a claim.

Your only defense is to take action by viewing the online Modifier 59 training by national coding expert Dawn Cloud, CPC, CMSCS, CHCI. You’ll receive the tools you need to finally get a firm handle on complying with modifier 59 guidelines – including its sub-modifiers XE, XS, XP and XU.

Here are just a few of the practical, step-by-step modifier 59 strategies you’ll receive by registering for this 60-minute online training session:

• Never mix up modifiers 59, 51 (Multiple Procedures) and50 (Bilateral Procedures) again
• Audit proof documentation phrasesto justify your use of the 59 sub-modifiers
• Reduce denials by accurately incorporating the 2018 CCI edits for proper use of Modifier 59
• Don’t allow E/M services and modifier 25to confuse correct modifier 59 usage
• Decipher CorrectCoding Edits (CCI) 0, 1 and 9 as a key to unlock correct modifier application
• Maximize reimbursement with usage strategies for sub-modifiers XE, XS, XP, XU
• Correctly apply modifiers in the right order and to the right codesto get paid accurately
• And so much more…

IMPORTANT: You may think that if you don’t bill Medicare you don’t have to worry about this, but think again. Although modifier 59 primarily affects Medicare claims – private insurers are quickly following suit.

And remember, ignorance is not an acceptable defense against fraud violations. If you are targeted for an audit and found to be applying modifier 59 and its sub-modifiers incorrectly, or if your documentation doesn’t back up their use, you’ll most certainly regret it.

Don’t risk it, register for this must-attend modifier 59 training session today and finally have the confidence that these complex and dangerous modifiers won’t leave you open to audits and penalties.