Wiki Additional Modifier Needed?

[hunterbht]

Hi all!

I have a question on an E/M billing edit / kickback from the software edit.

Received the following message on:

99213 - 25

20610

89060-26

the edit return was additional modifiers needed. What is missing? What am I not catching?

THANK YOU!

 

[mitchellde]

I usually use an anatomic modifier on the 20610 for LT or RT joint. Perhaps the vendor is gearing up for the more specific ICD-10 CM codes which are defined by Lt side and RT side.

 

[johnmeyer]

I think Debra hit the nail on the head. We have been using the LT and RT mods for joint injections and it passes the edits.

 

[seanny]

Debra is right. The 20610 needs Rt, Lt, or 50. Interestingly enough, however, Mcaid NC denied 20610 in 2012 with the anatomic modifier, but it works for all others.