QUEST Integration – Modifier Code 59

Original Effective Date:

12/01/2003

Current Effective Date:

01/01/2015

Modifier Code 59

This modifier is used to identify distinct procedural services performed by the same physician on the same day. Modifier 59 may represent:

• A different operative session or patient encounter.
• A different procedure or surgery.
• A different site, separate incision, separate lesion, or separate injury (or area of injury in extensive injuries).

When another modifier is appropriate that explains the circumstances more clearly, it should be used rather than modifier 59. Modifier 59 does not replace modifiers 24, 25, 50, 51, 78, or 79. Modifier 59 should only be used if another, more descriptive modifier is not available to explain the circumstances.

Example

A physician may excise two suspicious breast lesions on the left breast on the same day. The physician may choose to use modifier 59 to make it clear that he is billing for the excision of two separate lesions. Billing may be done as follows:

Revision History