Modifier -59 is referred to as what type of modifier?

Modifier -59 is categorized as a "modifier of last resort." This designation means that it is used to indicate that two procedures that are typically bundled together should be reported separately due to distinct circumstances. Specifically, it is applied when a procedure or service performed is distinct or independent from other services performed on the same day.

The need for modifier -59 arises in situations where the procedures are performed on the same day but are not mutually exclusive. It serves to clarify that there was a valid reason for providing these services separately, which may not be clear from the procedure codes alone. The intent is to ensure appropriate billing when separate payment is warranted, reflecting the complexity or unique nature of the patient's care on that day.

Understanding this modifier is vital for accurate coding and reimbursement, as its application helps protect against denials or audits when the services provided are legitimate and fall outside the normal bundling criteria. Proper usage of modifier -59 ensures that healthcare providers are compensated fairly for the comprehensive care they provide to their patients.