Forum - Questions & Answers

Sep 7th, 2011 - ravikumar

Modifiers

How to differentiate 50 and 59 modifier?
Please provide explanation with examples for usage of 50 and 59 modifier.

Sep 9th, 2011 - DebraS   67 

re: Modifiers

50 = bilateral (only to be used with those procedures that do not have bilateral in the CPT® description). 59 is when one procedure is bundled into another procedure per CCI/AAOS edits or guidelines. If the second procedure is in fact separate (site, wound, portal, compartment, organ system, lesion....) then you'd use a 59 on the procedure indicated as bundled or the lesser value one since you put your procedures in value order. This tells the carrier that under these circumstances as indicated in your op note that it is not bundled. Never use the 59 just to get a claim paid if it's not in fact separate. This is a big red flag if not used properly.



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