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59 modifier on 96372 for E/M with EPO injection

  1. #1
    Default 59 modifier on 96372 for E/M with EPO injection
    Medical Coding Books
    I was advised to use the 59 modifier on 96372 for admin of Epo (J0885) on the office visit of 99215-25. I just need to confirm if this is correct. It was my understanding that the 25 modifier on the E/M was sufficient.

  2. #2
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    Dover Seacoast New Hampshire
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    Default
    Some payers want the -25 on the E&M at the same time as a therapeutic injection, but correct coding tells us we do not need a modifier at all. In any case, the -59 would not be appropriate. That's used for two or more procedures, and E&M is not considered a procedure.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  3. #3
    Default
    Quote Originally Posted by Pam Brooks View Post
    Some payers want the -25 on the E&M at the same time as a therapeutic injection, but correct coding tells us we do not need a modifier at all. In any case, the -59 would not be appropriate. That's used for two or more procedures, and E&M is not considered a procedure.
    Thanks Pam

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