Wiki 62311 & 77003

[HeatherRose1122]

The CCI Edits state that 77003 is inclusive to 62311 when they are billed together. However the edits do state that a 59 modifier can be used in certain circumstances. Does anyone know when adding the 59 modifier would be applicable? What are examples of situation where the 59 modifier can be used with this procedure code combination? Has anyone had any success in the past 6 months of getting both codes paid by any insurance?

 

[thomas7331]

The 77003 guidance is inclusive to 62311 so the modifier would only really be appropriate if it was done for a purpose unrelated to the injection procedure.

Since 77003 is not something that's normally done all by itself, the only situation I can really think of where it would be appropriate to bill the 62311 and 77003-59 modifier would be if an additional procedure was done on the same day for which guidance was not inclusive and you needed to bill the guidance for that procedure but prevent it from bundling to 62311.