Awareness : OBC Tips

Use of Modifier 59

It is important that hospitals comply with Medicare billing requirements when it is deemed necessary to use modifier 59, which indicates that a procedure is separate and distinct from another procedure performed on the same patient on the same day. In particular, some hospitals incorrectly bill outpatient right heart catheterizations (RHCs) that are performed during the same patient encounter as endomyocardial biopsies (heart biopsies). By appending modifier -59 to the Healthcare Common Procedure Coding System (HCPCS) code, hospitals represent that the RHCs were separate and distinct from the heart biopsies; however, the payment for a heart biopsy is generally intended to cover an RHC when the RHC is performed during the same encounter.