Wiki 96372 denials

[LYNNRAFFERTY]

Our office is billing for an office visit (99214-25), J0702, 96372, & 69209. The admin fee (96372) is being denied by both Medicare and Blue Cross. What additional modifier is needed? I would greatly appreciate some feedback!

 

[thomas7331]

96372 bundles to 69209 (as it does to almost all surgical procedures) so would need a modifier 59 (or XE/XP/XS/XU) to unbundle it if the documentation supports that the injection was unrelated to the procedure.

 

[LYNNRAFFERTY]

For clarification, you're saying add 59 modifier to 96372?

 

[OncologyOKC]

For clarification, you're saying add 59 modifier to 96372?

Only if the injection is not related to the 69209. Why was it given? anything other than the issue with the cerumen build up/removal and you can add the 59 to 96372

 

[Agilbert3]

Modifier 51

Hello,
I am wondering why the modifier 59 would be chosen. I would have chosen 51. It seems a bit silly to have to distinguish an ear lavage from an injection.

 

[OncologyOKC]

Hello,
I am wondering why the modifier 59 would be chosen. I would have chosen 51. It seems a bit silly to have to distinguish an ear lavage from an injection.

You are not distinguishing an ear lavage from an injection. You are identifying that one service is not related to another; that the injection is a completely separate service from the lavage. (again, assuming that is the case; the earlier question is not exactly clear on what the 96372 is for)

Modifier 59 is typically used to override NCCI Edits. Code pairs not normally payable on the same date of service but may be paid in some circumstances when reported with an appropriate modifier (often modifier 59) and supported by documentation that demonstrates why the services are distinctly separate.