Wiki Modifier 59 on injection in UC

[jplichta]

Hey all,

Wondering if you can help me with this: AAPC Coder and Supercoder are not showing an NCCI edit for the 59.

Assuming all the documentation supports the CPTs in this situation, would you add the 59 to the injection CPT 90471, this would be per CMS guidelines. They do show possibly adding a 51 for private payors.

99204-25, 11740, 90471, 90715, 73140. I am new to the injection/Urgent care world so I am hoping someone could give me some guidance with supporting documentation.

Thanks so much!

 

[tabytha]

I would not add the 59 as it is not inclusive but I would use the ICD 10 code Z23 as the first listed diagnosis on the injection code.

 

[jplichta]

I would not add the 59 as it is not inclusive but I would use the ICD 10 code Z23 as the first listed diagnosis on the injection code.

Thanks for the reply tabytha, do you have any reason why or documentation to support this? I am not finding much information on this and what I do seems to contradict each other.

 

[jplichta]

Could this have anything to do with the clearing house that scrubs the claims having this edit?