Wiki Help with modifier

[daedolos]

99213-25

20605-RT,AG with Dx: S43.121D
J1030
20610-RT,AG with Dx: M75.111
J1030

and denial is for both injection codes specifically INCCD10-HCPCS MODIFIER IS MISSING/INCOMPLETE/INVALID.


Peace
?_?
This is a Medi-Cal claim. What other modifier or what changes do I make?

 

[mitchellde]

it may be that you are trying to code for a non traumatic condition and a trauma diagnosis on the same location. What did the provider document as the reason for these injections? also both diagnosis indicate major joints and you have injection codes for a major joint and a medium joint.

 

[daedolos]

There was pain in the AC joint from a Grade 3 separation then there was rotator cuff tear on the same side. The doctor addressed both issues with injections.

Peace
@_*
The AC joint is listed in the description for 20605. Also, this is a Medicare with secondary patient. I was wondering if I had to append a 51 modifier to the 20605 as it is the lesser code.

 

[mitchellde]

There was pain in the AC joint from a Grade 3 separation then there was rotator cuff tear on the same side. The doctor addressed both issues with injections.

Peace
@_*
The AC joint is listed in the description for 20605. Also, this is a Medicare with secondary patient. I was wondering if I had to append a 51 modifier to the 20605 as it is the lesser code.

if the injection was provided for pain then you may need a G89 code for either acute or chronic pain (must be documented by provider) as the first listed - dx code. Please reference the guidelines for pain coding. Also you may need an XS modifier on the 20605 code to indicate separate site. The 51 modifier will only indicate that both were given in the same session.

 

[daedolos]

Both injections were given at the same visit. I'll follow up with the advice you've given. Thank you so much.

Peace
@_*