What is the purpose of modifier -59?

Modifier -59 is used to indicate a distinct procedural service that is not typically reported together with another service on the same day. Its primary purpose is to provide clarity when multiple procedures are performed during a single encounter, ensuring that the billing reflects the unique nature of each procedure. For example, if a surgeon performs two different procedures on the same area of the body, modifier -59 helps to differentiate the services provided, indicating that they are separate and not bundled into one common procedure. This is crucial for proper coding and reimbursement, as it prevents the insurance claim from being denied or underpaid due to the perception that the procedures are related when they are not.

The effectiveness of modifier -59 rests on its role in promoting transparency in billing practices, helping healthcare providers ensure they receive appropriate compensation for all the services they perform.