Name of Manual - Blue Cross and Blue Shield of Minnesota

Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (10/05/11)
Coding Policies and Guidelines (Modifiers)
MOD Description Submission Guidelines Impact to Payment
-59 Distinct
Procedural
Service
Modifier –59 may be appended to identify
non-E/M procedures/services that are not
normally reported together, but are
appropriate under the circumstances.
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. Modifier –59 is
always appended to the component or
lesser procedure code. Documentation
supporting the separate and distinct status
must be present in the patient’s medical
record.
A -59 modifier may be appropriate to
indicate a:
Different session
Different procedure
Different anatomical site or organ
system
Separate lesion
Separate incision or excision
Separate injury
Note: Requests to add a modifier -59 to a
denied service must follow the
replacement claim process. An
adjustment request will not be
allowed.
-62 Two Surgeons The use of this modifier is appropriate to
identify the use of two primary surgeons
when required during a surgical procedure.
Documentation should be submitted to
support the use of the –62 modifier.
Modifer-59 may not
affect edits or
payment. However, if
applicable, the
modifier should be
appended to the
service. Generally,
the –59 modifier is
only applicable to
those code
combinations noted in
the Correct Coding
Initiative (CCI) code
list with a modifier
indicator of “1” which
specifies the services
are distinct and
separate and thus
allowed. Service
denied may be
considered on
subsequent appeal.
Payment will be
determined based on
the Medicare
Physician Fee
Schedule Database
(MPFSDB) indicators
1 or 2 and based on
Medical Review of
supporting
documentation.
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