NCCI Edits Alert - Modifier 59

This message is alerting the biller that modifier 59 is allowed per the National Correct Coding Initiative (NCCI) rules. There are certain CPT codes that are considered "mutually exclusive," meaning that the two procedures cannot be performed during the same patient encounter. Modifier 59 is used to indicate a "Distinct Procedural Service” to distinguish it from other procedures performed that day. Modifier 59 does not need to go on every procedure code in a visit, but if two codes are mutually exclusive, it may be used on one code to identify that these were two independent procedures and should be paid as such. 

 

There is a specific list that lists which codes are mutually exclusive and which ones would require modifier 59. Depending on the procedures performed, modifier 59 might not be required in the visit at all. You can download that list here if you want to manually search to see if 59 is needed on a procedure. In general, you do not need to manually add modifier 59 because EZDERM adds it automatically when the note is signed off. But, let's say the provider manually adds a code after sign off that requires modifier 59. EZDERM will display this alert to tell them 59 is allowed per the NCCI edits. 

 

You can bypass this alert, but if you submit this claim without modifier 59 on 17000 you run the risk of insurance denying payment on 17000 because they will "bundle" payment with 17262.