Wiki MOD 25 or 59?????

[Sunshine06]

Hello and help!

We've have been uneasy when it comes to using the appropriate modifier and want to make sure we are doing it correctly(not just for reimbursment). After doing some research we've become even more confused! A patient comes in to get tested for a STI due to symptoms. The APRN examines the patient and orders a rocephin injection. What is the appropriate way to code this:

99213-25 or 99213
86592 86592
86703 86703
87491/87591 87491/87591
J0696 J0696
96372 96372-59
The first seems correct to me but then there is disagreement because it was stated that the injection is bundled into the OV. According to my research, the injection is a seperate identifiable procedure. Please explain your answer and attach any links that may help. Thank you!!!!

 

[maddismom]

The 25 on the OV should be sufficient. Not sure where the 59 comes into play? You have an OV with a minor procedure (injection). Have no idea about your lab codes.

 

[ABridgman]

I would have just used 25.

I agree with above, no idea where or why the 59 is even coming up.

59 is only used on non E/M services. It is used to separate non E/M services that would normally be bundled.