Wiki Modifier 79-Osteoarthritis

[LLRodgers]

Hello,

Can anyone tell me if I have a fractured toe (still in global period) but the patient comes in for a bilateral routine knee injections do I put the modifier 79 on both injection codes or just one.

Ex: M17.0 - B/L Osteoarthritis
20610 RT - 79
20610 - LT - 79

of

do you only put it on one of the injection codes?

Thank you,
LLR

 

[hopepg]

I would say add the 79 to both. You are basically telling the payer that 20610 RT & LT are unrelated procedures to the previous toe fracture. Instead of saying just the LT or the RT is unrelated.

Our common sense would say that the payer should see different diagnosis codes (for the toe fracture encounter & the knee injection encounter) & allow for payment on the 20610 codes but it's never that easy with payers

Side note, follow up with the payer to see if the bilateral ICD10 code being used on the procedure with the RT or LT modifier rejects.

For example,
For payers that prefer we itemize out the CPT 20610 on two lines, our orthopedic office will use the unilateral ICD10 code to match with the unilateral procedure.
For payers that prefer bilateral billing, our orthopedic office will use the bilateral ICD10 code to match with the bilateral procedure (20610-50).
Other coders will probably have different opinions on this (I've seen it in these forums since ICD10 implementation) but this is how we bill these scenarios & we don't see specific reimbursement issues (for this at least!).

 

[LLRodgers]

Modifier 79

Thank you for the quick response it is very much appreciated. This provider wants us to use the 20610 RT and 20160 Lt they have denied other claims with the 20610-50.

Again Thank you!
LLR