Modifier 59 w/ injections


Greenville, SC
Best answers
I have an insurance company that is denying some injection claims. We billed 20610 for a shoulder injection and patient also had a trigger finger injection during the same visit which was billed 20550 (59). They want reasoning as to why the trigger finger injection should be paid. Is this not correct??? We're only having difficulty with one ins. co. with this.....Any help would be appreciated! Thanks!

Per CCI edits that would be correct. Have you tried using a 51 modifier instead? I have an insurance that won't take the 59 because they want the 51 instead, once we started using that we started getting paid on numerous procedures.
Since more and more insurance companies appear NOT to be requiring modifier 51 due to their own claims processing audit settings, it actually is very useful to know WHICH ones do. I've often wondered how many still do and think it's a good idea to compiile a list of the ones who do require it.
Suzanne E. Byrum CPC
(Noridian MCR-WA State)