Modifier 59 usage

mgarcia400

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Can someone please advise on the correct usage of a possible use modifier 59?
I work at family practice and billed an encounter as follows: This patient had a Kenolog injection as well as Bupivacaine in left shoulder.

99214- 25
C92290
J3301
20610 (injection of admin of major joint)

The 20610 was denied for NCCI edits., Column 1 and 2 codes. Would it be appropriate to add modifier 59 to 20610. Any insight for appropriate coding is appreciated.
 
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Hello!

The 20610 should not need a 59 modifier since it is the only procedure and you have already differentiated the E&M with a 25 modifier. However, the 20610 will need a modifier to specify laterality, in this case it would be LT.
 

mgarcia400

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Hello!

The 20610 should not need a 59 modifier since it is the only procedure and you have already differentiated the E&M with a 25 modifier. However, the 20610 will need a modifier to specify laterality, in this case it would be LT.
Thank you. It did have the LT modifier, I left that part out. So sure thing we will not be receiving additional payment for 20610 as NCCI stated?
 
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The local anesthesia is typically not reported separately for this procedure, only the Kenolog would be billed. Additionally, for some payers the primary diagnosis code on the E&M may have to differ from the diagnosis on the injection to receive reimbursement for both. Other than that, I'm not too sure, I'm sorry!
 
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