Modifiers needed

My Doctor is billing CPT® codes 29888, 29882, 27427-52 & 20680. Do I need to use modifier -59 on 29882, 27427-52 & 20680? Commercial Insurance billing. Someone said using -59 on all codes is incorrect.

re: Modifiers needed

CMS definition of modifier 59 is as follows:

“Distinct Procedural Service: Under certain circumstances, it may be necessary to
indicate that a procedure or service was distinct or independent from other non-E/M
services performed on the same day. Modifier 59 is used to identify
procedures/services, other than E/M services, that are not normally reported
together, but are appropriate under the circumstances. *Documentation must support
a different session, different procedure or surgery, different site or organ system,
separate incision/excision, separate lesion, or separate injury (or area of injury in
extensive injuries) not ordinarily encountered or performed on the same day by the
same individual. However, when another already established modifier is
appropriate, it should be used rather than modifier 59. Only if no more descriptive
modifier is available, and the use of modifier 59 best explains the circumstances,
should modifier 59 be used.* Note: Modifier 59 should not be appended to an E/M
service. To report a separate and distinct E/M service with a non-E/M service
performed on the same date, see modifier 25.”

So, the general rule for billing is, you can use modifier 59 for any code that meets the circumstances outlined by the definition and is supported by the documentation of the procedures. Modifier 59 should not be used in an attempt to get every CPT® paid (this is considered inappropriate usage of the modifier), but it is possible that it's appropriate to append the modifier to every CPT® code IF each procedure performed does indeed meet the requirements of "different session, different procedure or surgery, different site or organ system,
separate incision/excision, separate lesion, or separate injury."

Also some insurance companies will bundle CPT® codes regardless of your usage of modifier 59, especially if you're trying to bill code pairs that are bundled under the NCCI rules (National Correct Coding Initiative, you can Google it and download the list of bundled codes to check against what you're trying to bill separately).

Sorry, the answer is long and not "yes" or "no" because using this modifier really does depend on the circumstances of each procedure performed. It's up to you to code from what the documentation says, and avoid the temptation of adding the modifier to everything without first checking on whether it meets the requirements. A lot of coders do this and it's not right, it leads to more headaches and audits and work down the road for the doctor. Sure, it looks good initially when the payments are high but then it slowly trickles back out when the claims get audited. Best to explain this upfront to the doctor, and that a slightly smaller payment upfront could mean less work and hassle on defending the coding later on.