{"id":11229,"date":"2015-02-18T09:25:03","date_gmt":"2015-02-18T14:25:03","guid":{"rendered":"http:\/\/www.poweryourpractice.com\/?p=11229"},"modified":"2025-06-27T09:58:34","modified_gmt":"2025-06-27T09:58:34","slug":"getting-the-most-from-modifier-59-25-and-91-a-guide-for-coders","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/getting-the-most-from-modifier-59-25-and-91-a-guide-for-coders\/","title":{"rendered":"Getting the Most from Modifier 59, 25 and 91: A Guide for Coders"},"content":{"rendered":"

\u201cIf it isn\u2019t coded, then it hasn\u2019t been done.\u201d <\/span><\/p>\n

Correctly applying modifiers<\/span><\/a>, though, isn\u2019t always as easy as it seems. Many times providers inappropriately use modifiers, an action that inevitably can lead to claim denials.<\/span><\/p>\n

\u201cModifiers are essential tools in the coding process,\u201d says Laura Reeds, director of coding compliance at IASIS Healthcare in Franklin, Tenn. \u201cThey clarify how things should be paid \u2026 and further explain or qualify a CPT code.\u201d<\/span><\/p>\n

CPT modifiers (also called Level I modifiers) supplement the information or adjust care descriptions to provide extra details about a procedure or service provided by a physician. Code modifiers help further describe a procedure code without changing its definition.<\/span><\/p>\n

Let\u2019s take a look at 3 commonly misused modifiers, and see how they\u2019ve been applied to different care situations.<\/span><\/p>\n

Modifier 59<\/h2>\n

CPT Manual defines modifier 59 as a\u00a0\u201cDistinct Procedural Service.\u201d<\/span><\/span><\/span><\/em><\/span><\/p>\n

CMS says coders most often misuse modifier 59. Clinicians normally use modifier 59 to show that they performed two or more procedures during the same visit to different sites on the body.<\/span><\/p>\n

Unfortunately, it was too often applied to prevent a service from being bundled or conjoined with another service on the same claim. Perhaps to prevent overuse or even abuse, <\/span>CMS recently announced significant changes to modifier -59<\/span><\/a>, essentially transforming this modifier into 4 more specific \u2018X codes.\u2019 <\/span><\/p>\n

\n

EXAMPLE OF MODIFIER 59 CHANGE to an \u2018x code\u2019:<\/span><\/strong><\/p>\n<\/div>\n

A dermatologist does a Photo Dynamic Therapy session with a BLU-U machine on the face\/scalp of a patient. Following the face\/scalp session, the BLU-U was repositioned to treat extremities.<\/span><\/p>\n

Coding examples:
\n96567
\n96567-XS (formerly 96567\u201359)<\/p>\n

The first code is the face\/scalp performed on the patient. Then, modifier X code \u201cXS\u201d for \u201cSeparate Structure\u201d is added to the second procedure, indicating a distinctly different procedure performed on a separate organ\/structure.<\/p>\n

Modifier 25<\/h2>\n

In Appendix A, the CPT 4 Manual defines modifier 25 as:<\/span><\/p>\n

\u201cModifier 25 is a Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service.\u201d<\/span><\/em><\/p>\n

Physicians can use this modifier to show that on the day they performed a procedure or service (identified by a CPT code), the patient\u2019s condition required a significant, separately identifiable E\/M service above and beyond the other service provided.<\/span><\/p>\n

When Not to Use the Modifier 25:<\/span>
\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span>Do not use a 25 modifier when billing for services performed during a postoperative period if related to the previous surgery.<\/span>
\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span>Do not add modifier 25 if there is only an E\/M service performed during the office visit.<\/span>
\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span>Do not append modifier 25 to an E\/M service when performing a minimal procedure on the same day unless you can support the level of service as significant, separately identifiable.<\/span><\/p>\n

\n

EXAMPLE OF MODIFIER 25 SITUATION:<\/span><\/strong><\/p>\n<\/div>\n

A patient visits the cardiologist for an appointment complaining of occasional chest discomfort during exercise. The patient has a history of hypertension and high cholesterol. After the physician completes an office visit, the doctor determines the patient needs a cardiovascular stress test that same day.<\/span><\/p>\n

Coding example:
\n99214 \u2013 25
\n93015<\/p>\n

The physician codes an E\/M visit (99214) and he or she also codes for the cardiovascular stress test (93015). They add modifier 25 to the E\/M visit to show that there was a separately identifiable E\/M on the same day of a procedure.<\/p>\n

Modifier 91<\/h2>\n

Modifier 91 indicates when the same provider performs repeat tests on the same day. In this scenario, the clinician obtains reportable test values with separate specimens taken at different times, and only when it is necessary to get multiple results in the course of treatment.\u00a0 When billing for a repeat test, use modifier 91 with the appropriate procedure code.<\/span><\/p>\n

When not to use modifier 91:<\/span>
\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span>Rerun of a laboratory test to confirm results<\/span>
\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span>Rerun due to testing problems with the specimen<\/span>
\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span>Rerun due to testing problems with the equipment<\/span>
\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span>When the procedure code describes a series of tests<\/span>
\n\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span>For any reason when a normal, one-time result is required<\/span><\/p>\n

\n

EXAMPLE OF MODIFIER 91 SITUATION:<\/span><\/strong><\/p>\n<\/div>\n

A patient with high blood pressure who has been on a low-salt diet may receive a plasma renin activity (PRA) test (84244 Renin) in the morning in the supine position. Because physicians may use variations in PRA levels due to time of day and patient position to evaluate certain conditions such as hyperaldosteronism, they may order a repeat renin in the afternoon with the patient standing upright for a period of time.<\/span><\/p>\n

Coding example:
\n84244
\n84244 \u2013 91<\/p>\n

Report the second 84244 with modifier -91 to show that the lab performed two separate renin assays for the same patient on the same day.<\/p>\n

For more information on these and other modifiers, see the\u00a0<\/span>CPT (Current Procedural Terminology)<\/span><\/a>\u00a0and <\/span>HCPCS (HCFA Common Procedural Coding System)<\/span><\/a> codebooks.<\/span><\/p>\n

Xavier E. Martinez contributed to this post. <\/span><\/em><\/p>\n

Outsourcing your medical billing to experts can reduce modifier misuse and confusion. See our <\/span>In-House vs. Outsourced Medical Billing Revised: Pros and Cons<\/span> post to learn if outsourcing is right for your practice.<\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

\u201cIf it isn\u2019t coded, then it hasn\u2019t been done.\u201d Correctly applying modifiers, though, isn\u2019t always as easy as it seems. Many times providers inappropriately use modifiers, an action that inevitably can lead to claim denials.<\/p>\n","protected":false},"author":1,"featured_media":32787,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[192,53,193,153,194,195,39,154],"class_list":["post-11229","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revenue","tag-guide-for-coders","tag-medical-billing","tag-medical-coding","tag-modifier-59","tag-modifier-25","tag-modifier-91","tag-revenue","tag-x-codes"],"yoast_head":"\nA Guide for Coders: Modifiers 59, 25 and 91 \u2013 Continuum<\/title>\n<meta name=\"description\" content=\"Modifier 59 just got a makeover. Modifier 25 and modifier 91 can also be tricky. 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