Wiki 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.
 
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.
 
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?
 
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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