Modifiers?

[lopezk89]

I HAVE A PT THAT HAS COME IN FOR AN OFFICE VISIT AND SOME INJECTIONS. MY DR. HAS CODED THE VISIT AS AN OFFICE VISIT 99212 25 AND 20552 (6) INJECTIONS WITH NO MODIFIER. THE INJECTIONS WERE DONE IN AND AROUND THE LUMBAR AREA. I THOUGHT THE MOD 59 NEEDED TO BE USED. AM I CORRECT?

[danastiff]

If the documentation supports a significant, separately identifiable E/M service in addition to a procedure note for the trigger point injection, then you would assign 99212-25 and 20552. No modifier 59 is appropriate for this scenario. Medicare policy does not allow the E/M if it is the evaluation to determine the need for the injection, as stated in the NCCI Policy Manual.
I hope this helps

[cjacobs]

I do believe the visit is being billed incorrectly. If you read the codes in the CPT book, you should being billing a 99212 with 20552 and 20553 a modifier 59 will need to place on 20552.

[danastiff]

The injections are specific to the number of muscles and not to the number of injectios. So if all six injections were in 1 or 2 muscles only, then you would need only the 20552. If there were 3 or more muscles injected, then use the 20553. Do not use 20552 & 20553. You will use only one of the codes, depending on how many muscles were injected. No use of 59 is required.

[ollielooya]

Agreed, no modifier 59 for this scenario. We bill similar such events. Number of muscle groups is what determines as to whether 20552 or 20553 is billed, not the number of injections. If the documentation supports a significant, separately indentifiable E/M service in addition to the TPI injections, then yes bill wiith the office visit with modifier 25. If patient already was scheduled for the injections, then you would not bill the EM code, only the TPI's.

---Suzanne E. Byrum CPC