How to Properly Use the 59 Modifier on Your Physical Therapy Claims

If you are a physical therapist, you know that you need to use modifiers on your CPT codes when billing. The CCI edits dictate which CPT codes need to be billed with particular modifiers. One modifier that is often challenging to use correctly is the 59 modifier. In this article, we will discuss how to more easily know when to add the 59 modifier to prevent denial of claims.

One common scenario in which the 59 modifier should be used is when there is a significant difference between the service provided and the service that was described by the CPT code. For example, if you provide physical therapy services to a patient for an hour, but only 30 minutes of that time were actually spent providing treatment, you would use the 59 modifier to indicate that only 30 minutes of treatment were provided. This will help to ensure that your claim is not denied due to insufficient documentation.

Another situation in which the 59 modifier may be necessary is when you are billing for two separate procedures that were performed on the same day. In this case, you would use the 59 modifier to indicate that both procedures were done on the same date. An example of this would be billing for manual therapy and an evaluation on the same date of service.

It is important to remember that the 59 modifier should only be used when it is necessary. If you are unsure whether or not to use the 59 modifier on your claim, contact your billing company for assistance. They will be able to help you make sure that your claims are processed correctly and that you receive reimbursement for the services you have provided.

The CCI edits are updated every year to reflect any changes that may need to be made to physical therapy modifiers and when to use them. Make sure to stay up-to-date on the latest changes so you can continue billing correctly and receive the reimbursement that you deserve.

More Examples of Common Uses of the -59 Modifier:

– When a physical therapist provides two services during the same visit which are not usually provided together, such as a evaluation and treatment, use of modifier -59 is required

– If you provide an extended care episode that goes beyond the typical physical therapy session, use of modifier -59 is required

– If you perform a service that is normally bundled with another service, such as dry needling or electrical stimulation, and want to be reimbursed for providing only that one service, use of modifier -59 is required.

There may be other instances when it is necessary to use the 59 modifier on your physical therapy claims. However, these are some of the more common uses.

How to Easily Stay in Compliance and Prevent Denials:

The absolute best way to assure that your claims are being sent out correctly with the proper modifiers is to use a system that “knows” to add the modifier at the correct time once the therapist inputs the CPT codes. For example, if manual therapy (97140) and therapeutic activity (97530) are selected by the therapists, the billing system that you use should be smart enough to automatically add the -59 modifier. HENO has this capability to all modifiers and can be updated at anytime if changes arise.

If you don’t have this ability within the current billing software that you use, make sure you are review each claim prior to submittal. It will save you a lot of headache, time and money to get it right the first time!