Modifier 59 is used when procedures normally bundled together should be reported as distinct and separate procedures. The determining factor for using X modifiers is if a service that is usually part of a bundle should not be in a particular instance, for a particular patient, on a particular day.
Coding for Colonoscopies Based on Patient Risk
A high-risk colonoscopy is covered every 24 months and a low-risk colonoscopy is covered once every 10 years, so using the right code for each is important. Without a diagnosis to support high-risk patients, the service will not be paid.