Injection given twice same day different encounters

[Coding2]

I am confused on modifier 59. I am looking for clarification on a patient coming in at 8 am and 8 pm for an injection of Lovenox. Is this coded 96372 each visit with the 2nd adding modifier 59?

Thank you..

 

[Pat Liebl]

Modifier 59 Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision. Also 96372 is for the injection only not the drug. Use the 59 on the 2nd code. you might have to send notes if asked

 

[pedscoder]

I don't believe you need a modifier. I would simply bill qty 2 of 96372. The date of service is the same, the time doesn't matter.

 

[mitchellde]

time does matter and you should not bill the 96372 with units greater than 1. The other modifier that is acceptable in this scenario is the 76 for a repeated service, if it is the same drug for the same reason. that is administered in a different session on the same day.

 

[Coding2]

Twice in same day

Thank you for your help. Where would I find the units of 1 with 96372 listed for reference. I looked in the MUE and didn't find the 96372. Then a modifier would always be needed if different encounters and same proc done? Thank you.

 

[mitchellde]

yes it is always coded with a modifier. The units I found in the MCM under procedure quantities. Also I found it in the federal register. I am sorry I do not save the links for these things. But the logic is you did not administer tow units of the same service you performed the same service twice. This is why the modifiers exist.