When should you use Modifier 59, and how does it differ from Modifiers 51 and 91?

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Modifier 59 is used in CPT coding to indicate that two procedures that are normally bundled together were performed separately and distinctly under specific circumstances. It helps bypass National Correct Coding Initiative (NCCI) edits when justified.

✅ When to Use Modifier 59

Use Modifier 59 only when:

• Procedures are not normally reported together

• They were done at a different site or organ

• There was a separate encounter

• A different incision or lesion was treated

• It's medically necessary and well documented

📌 Example:
If a patient had excision of a skin lesion on the arm and another on the leg, and both codes would usually be bundled:

🚫 Don’t Use Modifier 59:

• Just to bypass edits without justification

• If another modifier (like X{EPSU} or 51) is more accurate

🧠 Summary:

• Use 59 to indicate procedures were done separately and are not duplicates.

• Use 51 when billing multiple procedures (e.g., multiple surgeries).

• Use 91 for repeat lab tests, not for errors or quality control.

Correct use of modifiers avoids denials, ensures proper reimbursement, and maintains coding compliance.

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