Wiki Need Help with Modifiers

[andrea_perrego@hotmail.com]

Could someone please help me out with placement of modifiers.

Claim was submitted as below. Line 2, 4, 5 and 6 denied. Invalid modifier, included in another procedure.

Line 1 99213 25 M76.52 Patellar tendinitis left knee, M25.362 Other instability left knee, M25.361 Other instability right knee
Line 2 20611 M76.52 Patellar tendinitis left knee
Line 3 20611 50 M76.51 Patellar tendinitis Right Knee
Line 4 29530 59 M76.52 Patellar tendinitis left knee
Line 5 29530 50 59 M76.51 Patellar tendinitis Right
Line 6 J2000 M76.52 Patellar tendinitis left knee

Thank you

 

[ntreber]

What jumps out at me is that you are using modifier 50 and 59 on the same procedure. Modifier - 50 is for a bilateral procedure. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.
I do not think they are to be used together on the same CPT code.

 

[mitchellde]

when you use the 50 modifier you bill only one line item, to 50 indicate bilateral
if you use two lines then you will not use the 50 you use either the RT on one LT on the second or one line with no modifier and the second line with the 59 or XS depending on the payer.
if you bill like 20611 and then 20611 -50 you are indicating 3 procedures

 

[daedolos]

99213-25
20610-50
29530-50

Peace
@_*
You can't code for J2000 because it's included in the 20610 procedure. Thanks, Mitchellde, for the clarification.