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-59 modifier

  1. Question -59 modifier
    Medical Coding Books
    I need some clarification on 59 modifier. here's the scanario... patient comes in for regular office visit (99213) he decides to also do osteopathic manip (98927) and give injection (j1100) admin (96372) So we place 25 modifier on office visit. Osteopathic Manip and Office Visit pays fine but Medicare denies (96372) saying that it bundled with (98927) and when i called medicare they told me to put a 59 modifier on the (96372) Can anyone point me to something to clarify why the 25 modifier would not be sufficient?

  2. #2
    CCI edits, 96372 is bundled with 98927 but a modifier is allowed.

    Laura, CPC, CEMC

  3. #3
    San Antonio, Tx
    Your modifier 25 was not the reason for the denial. Modifier 25 is for E&M codes only. Your Office visit paid because of the 25 modifier. You needed to get 96372 pd and the only way to do that (along with proper documentation) is to add the 59 modifier.
    Ray Galvez CPC

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