Neurology & Pain Management Coding Alert

Check out this dual-injection modifier 59/X scenario.

With all the details typically involved, coders can have difficulty reporting modifier 59/X (Distinct procedural services) claims for their providers.

To get an idea of the modifier 59/X concept in practice, consider this example:

An established patient presents to the physician with chief complaints of right elbow and left knee pain. The physician administers two separate injections after diagnoses of lateral epicondylitis in the right elbow and left knee primary osteoarthritis. Notes indicate that the physician injected steroids into the patient's left knee and performed a single tendon sheath/ligament injection on the right elbow.

In this instance, the physician provided a pair of injections that would normally be bundled. Since the injections were at different anatomical sites, however, you can code for them separately using modifier 59/X. on the claim, you would report:

First injection:

• 20610 (Arthrocentesis, aspiration and/or injection, major joint or bursa [e.g., shoulder, hip, knee, subacromial bursa]; without ultrasound guidance) for the knee injection
• M17.12 (Unilateral primary osteoarthritis, left knee) appended to 20610 to represent the patient's knee pain
• Modifier LT (Left side) appended to 20610 to show that the physician performed the injection on the patient's left knee.

Second injection:

• 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]) for the elbow injection.
• M77.11 (Lateral epicondylitis, right elbow) appended to 20550 to represent patient right elbow pain
• Modifier 59/XS (Separate structure) appended to 20550 to show that the injections should be considered distinct procedural services because they occurred at different anatomical sites.
• Modifier RT (Right side) appended to 20550 to show that the physician performed the injection on the patient's right elbow.