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NCCI Modifier Madness – No Need for that!

Written by: Darlene D'Altorio-Jones (1959-2015) on Wednesday, November 19, 2014 Posted in: Outpatient Rehab

Essentially, there is nothing different than your present practice. If you utllize the ’59’ modifier at this time because your billing combinations meet an NCCI edit either mutually exclusive and/or a component code of the charge you utilize, then if you want payment for that service and the code allows, you provide a modifier. After the first of the year, when a more specific modifier is appropriate, you may use that new code in preference to the standard 59 modifier.  If there is not a more specific code you can append an ‘XU’ or the ’59’ modifier as you are already accustomed to.

CMS will continue to recognize the -59 modifier, but notes that Current Procedural Terminology (CPT) instructions state that the “-59 modifier should not be used when a more descriptive modifier is available.” CMS lists the active dates for transmittals R14220 AND MM8863 within these links. In addition, there are updates to a modifier education article also available at CMS.

Modifier 59 – update – *note red print is newest information.

  • On page 3 of this link, a discussion on the use of the 59 modifier has been updated showing the new modifiers and how they should be used. The specific therapy EXAMPLE is on page 9 of the ‘modifier 59’ link.

Once again, look at your present practice. Do you utilize the 59 modifier given your practice type and clinic patterns? Do you often have multiservice treatments on the same day that generally require edits? Do you provide pool services on the same day as land treatment? Do you have clinic evaluations for orthotics, prosthetics, seating clinics, foot clinic or any other type of evaluations that may occur on a same date of service as a treatment that also meet the component criteria and allow modifier use?

Run a query through your billing department/software on the volume of use in past history for therapy triggered and use of modifier ’59’. Given the answer to this prevalent use information, you can then decide the strategy you will use to alert your staff to the utilization of the new codes. If your clinic has often needed or utilized this code on your past bills, chances are you have not changed patient types, scheduling practices and types of service; you will need to educate and utilize the newest descriptions for more specific 59 modifier usage if you choose to.   If you have limited historical use, educate appropriately but donu2019t fret about the small stuff.  CMS is not mandating use of the X codes just yet and is allowing therapy practices to continue with modifier ’59’.  (Updated 1/2015 ddj)

There is no need for NCCI modifier madness if you review and create the strategy you need based on historical practice.