Unbundling Confusion – Ophthalmology Management

This month we continue our discussion of modifiers. Modifier 59 is the “unbundling” modifier and much confusion and controversy continues about its appropriate use. I’ll try to offer clarity below.

This article answers the following questions:

  • How is modifier 59 defined in CPT?
  • When is modifier 59 used?
  • Can this modifier be applied in conjunction with other modifiers?
  • May you use modifier 59 to get around the NCCI edits if each procedure has a distinct indication and is preplanned?
  • Are different areas of the retina (e.g., macula and peripheral retina) considered different anatomic sites?

This article was published in Ophthalmology Management’s Coding & Reimbursement column, which is written by Corcoran’s Executive Vice-President, Suzanne Corcoran, COE. To view the entire article in Ophthalmology Management, click on the link below:


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