tci Part B Insider - 2014 Issue 14

Physician Notes: Noridian's Modifier 59 Notice Shocks Coders

Plus: ‘New’ CMS-1500 is effective now. A little-noticed but highly confusing announcement that Noridian Medicare posted last fall has been causing coders to scratch their heads, and for good reason. The Part B payer has rejected some modifier 59 (Distinct procedural services) claims, citing a September announcement that “Modifier 59 is no longer considered a valid repeat modifier. Procedures billed with modifier 59 will be denied as exact duplicates.”  Although the word “repeat” is mentioned, many coders have focused on the second sentence of the statement, which seems to suggest that any procedures reported...

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