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96372 w/ or w/o mod 59

  1. #1
    Honolulu Hawaii
    Smile 96372 w/ or w/o mod 59
    Medical Coding Books
    Does anyone know whether or not we should be appending a mod 59 when there are multiple subq/im injections after the first 96372?

    99284 - 25
    96372 - 59
    96372 - 59
    (then your 3 J codes for drugs)

    Can you please also explain your answer and if possible site your reference if any? I am a bit confused as some say we should append it and some say we shouldn't if there is already a mod 25 on the E/M. Also if you do think that -59 should be appended can you please explain what would make it a 'distinct procedure'. Thanks

  2. #2
    Columbia, MO
    When you have multiple codes of the same number then you need to append the 59 modifier to the second and subsequent of the same number to show that three separte injections were performed at three distinct and separate sites. What makes it distinct and separate is that each injection is a diferent location even though it may be close to the same site as the first it is still a different site. Without the 59 modifer the payer will reject the 2nd and subsequent codes as dulicate entires. And you still need the 25 modifier on the E&M to support that the assessment is significant and separately identifiable from the procedures. My reference is the definition of the modifiers.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Honolulu Hawaii
    Thank you mitchellde! Your response and explanation really put things into perspective for me! I appreciate it.
    "Success is not a matter of chance; but a matter of choice. It is not a thing to be waited for, It is a thing to be acheived."

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