Wiki MOD-59 Inj Admin

[sunitabacchus]

I keep getting different answers from Medicare about this.

If we bill out: 96372 x3 and we put MOD-59 on the first one, Medicare will only pay 93672 once, regardless if we put MOD-59 on all 3 lines...

Is this correct?

 

[OCD_coder]

I bill 3 different Medicare MAC carriers at the company I work for, we add the sum total of units of IM injections (96372) on 1 line and no modifiers unless I have an IV infusion/push code on the same DOS.

I never bill Medicare carriers the injections on multiple lines, even with the modifier 59 they will deny any additional lines as duplicate and deny. I haven't had a denial by a Medicare carrier billing this way in over 5 years.

There are a few commercial carriers that want them listed 1 unit per line with modifier 59 on subsequent lines.

This is our personal experience and how we train our new coders.

 

[sunitabacchus]

I bill 3 different Medicare MAC carriers at the company I work for, we add the sum total of units of IM injections (96372) on 1 line and no modifiers unless I have an IV infusion/push code on the same DOS.

I never bill Medicare carriers the injections on multiple lines, even with the modifier 59 they will deny any additional lines as duplicate and deny. I haven't had a denial by a Medicare carrier billing this way in over 5 years.

There are a few commercial carriers that want them listed 1 unit per line with modifier 59 on subsequent lines.

This is our personal experience and how we train our new coders.

So on 1 line should we be billing 96372 at 3 units with MOD-59? Because even if we put MOD-25 on the office visit, Medicare still denies the first (and all) 96372 if we don't attach a MOD-59 to it.

Because right now we bill this as follows:
1. 99214-25 *paid*
2. 96372-59 *paid*
3. 96372-59 *dupl no pmt*
4. 96372-59 *dupl no pmt*
and only line 1 is getting paid.

Please let me know

 

[OCD_coder]

992XX - 25
96372 x 3 (no modifier)

I don't know who your Medicare carrier is, I have experience with Novitas, Cahaba, Noridian, NGS and Palmetto billing this format and do not receive denials in my offices. I have one small commercial carrier that wants them listed on a separate line with modifier 59.

Note: I have bill as many as 5 units and gotten paid on all 5. There is no MUE limit assigned to this CPT code. But I have heard, not experienced, that Medicare will not pay more than 6 units maximum.

 

[sunitabacchus]

I actually just finished speaking with a manager at Medicare, and he said that the claim needs to be billed as follows:

Example:
99214-25
96372-59
96372-76
96372-76
Followed by all necessary J codes.

So now I get to spend the next several hours working on this, haha.

Thank you so much for your help, I hope that I'll be able to reach out to you again in the future for assistance

 

[OCD_coder]

You spoke to an inexperienced Medicare rep that gave you incorrect information and the modifier 76 is incorrect as you are not "repeating" the IM injection as you are giving a different drug for each injection.

These will eventually come under closer scrutiny and potentially be "taken back". Just be aware.

 

[sunitabacchus]

You had me concerned after reading you last post. I called Medicare back and spoke with a different manager, and she also confirmed that any additional admin codes after the first one with MOD-59, so have MOD-76 attached to it.

She also provided me with a CMS website for further confirmation.
http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/SE1314.pdf

We're going to give it a try billing with the MOD-76, since it's on the same DOS.