Wiki Appropriate modifier/s

[cherylbr]

In the following situation what modifier/s are appropriate?

64415
64999
76942

2 nerve blocks (cervical plexus block required ultrasound)
(interscalene nerve block)
separate provider

Here is my thoughts 64415 XP LT (interscalene block by separate/different provider)
64999 XP LT (cervical plexus block by separate/different provider)
76942 59 XP (ultrasound needed cervical plexus block by separate/different provider)

I feel since the ultrasound was provided for the cervical plexus block (64999) and separate from the 64415 that 59 modifier needs to be applied.
Also, since these services are being provided by a separate provider that XP modifier is also warranted.

However, I am being told that these two modifiers are not be used in combination. I feel without identifying both situations (modifiers) the claim will not be reimbursed accordingly. Is there not exception to these modifier guidelines?

What is the most appropriate way to submit this claim?

Thank you for your help on this very confusing issue for me.

Cheryl

 

[kdlberg]

The purpose of the "X" modifiers is to replace modifier -59 with something more specific. Modifier -59 is used if there isn't anything else that fits. This guide from Novitas gives a bit more information: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144545