Wiki 96402 Twice Same Day, Same Drug?

[toria11]

Patient was receiving their first Firmagon (J9155) loading dose, the injection was split and given in the left and right abdomen. Would you bill 96402, 96402-59? The office is wanting to use modifier 76 but I don't think that's correct. Thanks.

 

[daniel]

Hi- Interesting case, I don't code office. Mainly the surgical procedures, but here's what I see.
This was found in the CPT Book for this section.
When the medical record documentation clearly identifies that it is medically necessary to separate a substance into two doses (i.e., two injections or infusions in different sites), it is appropriate to code both doses with modifier 59 or the appropriate X [E, S, P, U] modifier. The preparation of chemotherapy agent(s) is included in the service for administration of the agent and is not reported as a separate service. To report the intramuscular or subcutaneous administration of antiemetics, narcotics, or analgesics, see 96372.

I hope this helps.

 

[svt96cobra]

When we have this scenario, we bill 96402 on 1 line with 2 units because the MUE is 2. 76 modifier is not needed since it's not over the MUE.