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Most used, misused and abused – Ophthalmology Management

Modifier 59 is commonly called the “unbundling” modifier. It is both one of the most frequently used modifiers and the most misused. To rectify that, CMS has introduced new “X” modifiers for physicians and coders to learn.

This article addresses the following subjects:

  • How does CPT define modifier 59?
  • When should I use modifier 59?
  • But modifier 59 is appropriate when procedures are preplanned and have distinct indications, correct?
  • Are different areas of the retina (for example, macula and peripheral retina) considered different anatomic sites?
  • What are the new “X” modifiers?
  • When are these modifiers used?
  • May modifier 59 or the X modifiers be used with other modifiers?

This article was published in Ophthalmology Management, and 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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