Modifier 59: Stop Misuse and Avoid Costly Penalties

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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 registering for the upcoming modifier 59 online training by national coding expert Dawn R. Cloud, CPC. By attending this online training, 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) and 50 (Bilateral Procedures) again
  • Audit proof documentation phrases to justify your use of the 59 sub-modifiers
  • Reduce denials by accurately incorporating the 2019 CCI edits for proper use of Modifier 59
  • Don’t allow E/M services and modifier 25 to confuse correct modifier 59 usage
  • Decipher Correct Coding 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.

Here are some questions you’ll finally get the answer to, in order to code your claims more accurately, reduce denials and get paid more of what you deserve when applying modifier 59:

  • Can modifier 59 be used with other modifiers on the same claim (i.e. modifiers 25, 50, 51, 76, 79, or 91)?
  • Can add-on codes be applied with modifier 59?
  • Can modifier 59 be appended to an unlisted code?
  • Where does modifier 59 actually go?
  • When to use modifier 59 vs 51?
  • Can modifier 59 be used for DME claims?
  • Can the sub X modifiers be used on the same claim with 59?
  • Can the 59 modifier be used twice on a single claim?
  • What is the difference between modifier 59 each of the sub modifiers (XE, XS, XP, XU)?
  • Can modifier 59 be used with Lab codes?
  • Are there any specialties that should never use modifier 59?
  • Does the usage of modifier 59 affect which ICD-10-CM code is applied?
  • Should modifier 59 ever be used for hospital services?
  • Is there any special documentation that should accompany modifier 59 claims?

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. Don’t wait, sign up today.

Meet Your Expert

Dawn R. Cloud
CPC, CMSCS, CHCI, CPDMCertified Professional Coder

Dawn has 32 years’ experience in the Medical Industry. She is a Certified Professional Coder through AAPC since 1999. She is the Co-founder of the East Valley Chapter for AAPC in AZ. She has been published in multiple magazine and news articles. Her current role is working in Regulatory Research for one of the large Healthcare Facilities in Phoenix.

In this role she is constantly researching all regulations and guidelines that may affect our industry. She also has a consulting firm where she works teaching Coding Compliance, billing, and regulations for Specialists. Her specialties cover the gamut of medicine and surgery


Overall presentation was very informative, and detailed. Set up was easy.
Juanita Kakiva
Alaska Spine Institute, Billing Department
Overall presentation was excellent!!!
Tamra Munsell
Community Health Center, Revenue Cycle Lead
The speaker was very knowledgeable and informative
Silvana Velasco
Stone Oaks Family Doctors PA, Biller
It was very informative to learn about not only the uses of modifier 59, but also the other modifiers such as 50, 25, and X.
Rodrick West
Medstar Georgetown University Hospital, Senior Financial Analyst