# Modifiers w/ multiple major joint injections



## sopka9476 (Oct 23, 2014)

Hello,
I am having two issues lately.
1. When coding a bilateral major joint injection and a separate major joint injection performed on same DOS I used -50 for the bilateral procedure and -76 on the 3rd injection. This is no longer working and payment on the 3rd injection is being denied even after several appeal letters explaining there are 3 injections performed. For example, bilateral knee injections w/ -50 and a hip injection w/ -76. Help? Has anyone got any suggestions?
2. When coding 2 bilateral major joint injections. I used to code the first bilateral procedure w/ -50 and itemize the second bilateral injections out using -76 modifiers on the third and fourth major joint injection and now the third and fourth major joint injections are being denied payment. For example, bilateral knee injections and bilateral hip injection I would code as 20610-50, 20610-76, 20610-76. I really would appreciate any ideas?
Thanks


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## teresabug (Oct 23, 2014)

modifier 59 separate proc/separate body area


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## mitchellde (Oct 23, 2014)

sopka9476 said:


> Hello,
> I am having two issues lately.
> 1. When coding a bilateral major joint injection and a separate major joint injection performed on same DOS I used -50 for the bilateral procedure and -76 on the 3rd injection. This is no longer working and payment on the 3rd injection is being denied even after several appeal letters explaining there are 3 injections performed. For example, bilateral knee injections w/ -50 and a hip injection w/ -76. Help? Has anyone got any suggestions?
> 2. When coding 2 bilateral major joint injections. I used to code the first bilateral procedure w/ -50 and itemize the second bilateral injections out using -76 modifiers on the third and fourth major joint injection and now the third and fourth major joint injections are being denied payment. For example, bilateral knee injections and bilateral hip injection I would code as 20610-50, 20610-76, 20610-76. I really would appreciate any ideas?
> Thanks


76 is the incorrect modifier as it indicates a repeated procedure in a separate session on the someday.  This not a reaped procedure if it is performed on a different joint and it was not performed at a different session.  The correct modifier is the 59.  For the bilateral hip and bilateral knee, you would us the 
20610 50
20610 59 50
Make sure you link only the knee dx to one and only the hip dx to the other.


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## sopka9476 (Oct 24, 2014)

*Thanks, will do!*

Thank you ladies for your help and quick reply. I use modifier -59 to override edits and show distinction between multiple injections codes but did not think that it would be appropriate as there are no edits between 20610 & 20610 codes. But, will do! I have made the corrections to my claims using the -59 modifier and look forward to my payments on these charges soon. Thanks so much for your help!


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