Wiki Modifiers - injection code

[ryleeq92]

When a biopsy(11100) and an injection code(11900) are done on the same day which gets the modifier 59?

And also when a biopsy and a I&D(10060) are both done on the same day which one of those gets the modifer 59?

Thanks!

 

[emcee101]

due to it's higher RVU value, the 11100 would pe the primary code for both examples provided. the secondary code would receive the 59 modifier, but there is no CCI conflict for either example so a 59 modifier would not be needed.

If you are billing a non-Medicare insurance, you should attach a 51 modifier (muliple procedures) to the secondary procedure in both instances s othey are kept in correct order for reimbursement.

 

[CatchTheWind]

emcee101 is correct that neither of these codes bundles with 11100, so no modifier is needed.

However, I do want to clarify that the choice of which code to put modifier 59 on is not based on RVUs, but on which CCE column it falls in. (Column 2 gets the 59.) A classic example of this is 11100 with 17000, in which the 11100 gets the 59, even though it has the higher RVUs.