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Modifier 59 - injections and admin

  1. Question Modifier 59 - injections and admin
    Medical Coding Books
    For instance you have two IM/SQ injections, both are different meds, using the admin code 96372 x2 would you use 59 modifier? The two injections and admin are the only items on the ticket.

  2. #2
    Default
    You would only use the -59 modifier if you're doing (2) distinct or independent procedures from other non-E/M services performed on the same day. Your (2) units is just letting them know I did (2) IM injections but if there was not another distinct procedure done on the same day you do not need to use -59 modifier.
    Kiana CPC, CPC-H, BCS-M, BCS-R

  3. Default 59 Mod
    Thanks Kiana for your help.
    On those 2 injections-they were done for different diagnoses and meds, just that both were injections. So no mod 59 unless something else was done on that ticket also?

  4. Default
    That's where I would be confused too. Wondering if the different diagnoses would make them a different identifiable service because they are not related to each other.

  5. #5
    Location
    Bay City, MI
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    13
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    As a Payer, I would prefer it billed as 2 units. This would make since you will be also charging for two different meds.

  6. #6
    Location
    Columbia, MO
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    12,531
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    you really should be care when using units for services that are not listed as quantity distribution services. Such as drugs that come in quantities or timed services. There is much written about this and although some payers will pay with units the reimbursement is not always correct. Also there is an edit that can be rejected back for units out of range. I like to list each distinct and separate procedure as two line items with unit of 1 and use the 59 modifier on the second and subsequent. I always get the maximum reimbursement this way.

  7. #7
    Location
    Everett, WA
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    886
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    Quote Originally Posted by mitchellde View Post
    you really should be care when using units for services that are not listed as quantity distribution services. Such as drugs that come in quantities or timed services. There is much written about this and although some payers will pay with units the reimbursement is not always correct. Also there is an edit that can be rejected back for units out of range. I like to list each distinct and separate procedure as two line items with unit of 1 and use the 59 modifier on the second and subsequent. I always get the maximum reimbursement this way.
    So, if you have (for purposes of illustration) FOUR 96372administration codes: 96372(1), 96372-59 (1), 96372-59 (1), 96372-59 (1), the last two admins won't be denied as duplicate? ---Suzanne

  8. #8
    Location
    Columbia, MO
    Posts
    12,531
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    No they will not deny as duplicate. and yes that is the way I do it.

    Debra A. Mitchell, MSPH, CPC-H

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