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Modifier 59? Am i right?

  1. #1
    Default Modifier 59? Am i right?
    Clearnace Sale
    Good afternoon all,

    I am wondering if somebody could assist me in a denial from United Healthcare on a office injection (20552). United Healthcare is saying that his code needs a modifer, and after reading the procedure note, I am still unsure. The PA coded this visit on the billing sheet as 99213, 20552 x2.

    Im thinking 59 modifier as the 2 injections were in two different parts of the spine. Am I right?

    "PROCEDURE NOTE: After explaining the risks of the procedure such as bleeding, infection, pain, nerve injury, skin atrophy, fat pad atrophy, skin color changes among others, the patient consented to having the injections performed. After isolating both the superior and inferior trigger points on the right side of spine, rhomboids, after sterile prep ethyl chloride spray was used for anesthetic. Under sterile procedure, a 20 gauge 1-inch needle was used to enter the trigger point. No heme was able to be aspirated. At this point, in a fanning motion approximately 6 cc of 50% bupivacaine, 0.25% and 50%, 2% lidocaine with approximately 20 mg of Kenalog was injected into the area without difficulty.Direct pressure was held for hemostasis. This process was repeated on the inferior trigger point without complication."

    Thank you for your assistance!
    Marci A. Giardina, CPC

  2. #2
    Evansville Indiana
    Default trigger points
    First of all, if there was a separately identifiable E&M performed you would add a 25 modifier to the 99213. Secondly, 20552 is for single or multiple trigger points, 1 or 2 muscles so this would only be coded once. If you had 3 or more muscles it would be a 20553.

  3. #3
    hi, the 25 modifier is already in, united healthcare is saying that 20552 needs a modifier. sorry i was not clear....
    Marci A. Giardina, CPC

  4. #4
    20552 can only be billed once per CPT guidelines.

    Check the number of muscles injected if it was 1-2 then you only code for 20552, if it was 3 or more, then the appropriate code would be 20553.
    Mary, CPC, CANPC, COSC

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