Wiki Multiple Major Joint Injections

[jviggiani]

Hello! I am wondering if anyone has had issues with Medicare paying multiple joint injections? I know only two are allowed per session, but my issue is with two different non bilateral body parts. For a right knee and a left shoulder I am coding 20610,RT and 20610,59,LT. Medicare denies it for invalid modifier. I am certain this is their claim editing system but does anyone have any suggestions on how to get these paid the first time around? Thanks everyone !! I appreciate your input.

 

[kimberlywatson]

Hmm...you shouldn't need a 59 modifier if you have the RT and LT in place along w/ each associated diagnosis. Or perhaps they prefer the XS modifier in this scenario instead of the 59 as it's one of their more specified modifiers.

 

[Orthocoderpgu]

Medicare does not process claims with -59 since they came up with the -XS modifier for this situation so that is the modifier that you need to use. Additionally you can bill 20610 more than twice, you just need to appeal with medical documentation.

 

[jviggiani]

Medicare does not process claims with -59 since they came up with the -XS modifier for this situation so that is the modifier that you need to use. Additionally you can bill 20610 more than twice, you just need to appeal with medical documentation.

Thank you !! I will try the XS modifier. I do sometimes get the additional injections paid on appeal and sometimes not. I appreciate your response. Do the other major carriers recognize the X modifiers as well?

 

[Orthocoderpgu]

Thank you !! I will try the XS modifier. I do sometimes get the additional injections paid on appeal and sometimes not. I appreciate your response. Do the other major carriers recognize the X modifiers as well?

Some private carriers will recognize the -XS modifiers, but you just have to keep track as you go along.

 

[jviggiani]

Awesome. Thanks again. You've been extremely helpful!

 

[HeatherW2020]

For Medicare we have always billed 26010 with a 50 modifier if bilaterally done and then if medication was given use the RT/LT on the J code. We haven't had any issues with payment.

 

[jviggiani]

Thank you !

 

[jviggiani]

Hmm...you shouldn't need a 59 modifier if you have the RT and LT in place along w/ each associated diagnosis. Or perhaps they prefer the XS modifier in this scenario instead of the 59 as it's one of their more specified modifiers.

Thank you !