Q&A Modifier 59

[Kim Pressley]

Frequently in PT two different sites/issues will be treated during the same visit. As you know, this can produce an edit requiring modifier 59. The issue we are running into is the providers refuse to document the different procedures/sites to allow us to back up adding this modifier. We use 3M which, of course, targets Medicare/Medicaid edits. Today upon requesting this documentation, the provider cited that since the payor was not Medicare/Medicaid it was not even necessary to include this modifier. Is this true? If so, where would I find this guideline?

Thanks in advance!

Kim

 

[Melissa Caswell]

Many commercial payors follow Medicare guidelines as well. Also, if it is a contracted payor, you would need to abide by the contractual agreement between them and the provider in terms of billing.