Wiki Modifier 59

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I have a question about the webex course "Modifier Maze." I am attaching one page from this presentation with my question. There is a diagram provided to help determine if a modifier 59 should be used. If a patient undergoes a left total knee arthroplasty (27447) and also has a right knee injection (20610), would this be coded as 27447-LT with 20610-51-RT? Or 27447-LT with 20610-59-51-RT?
 

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