Modifier 59 Audits Denials and Post-Op Pain Injections

Modifier 59 (Distinct Procedural Service) continues to face intense scrutiny in 2026 due to widespread misuse, triggering audits, denials, appeals, and payer recoupments tied to medical necessity concerns. With enforcement on the rise, it’s more important than ever for coders to understand when—and when not—to apply this modifier correctly.

On today’s episode of the CodeCast Podcast, Terry Fletcher breaks down proper Modifier 59 usage, common pitfalls leading to audits, and key documentation requirements to support compliant coding. She also covers post-operative pain injections, including when they can be reported and which providers are eligible to bill for them.

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