# MOD-59 Inj Admin



## sunitabacchus (May 19, 2014)

I keep getting different answers from Medicare about this.

If we bill out: 96372 x3 and we put MOD-59 on the first one, Medicare will only pay 93672 once, regardless if we put MOD-59 on all 3 lines...

Is this correct?


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## OCD_coder (May 19, 2014)

I bill 3 different Medicare MAC carriers at the company I work for, we add the sum total of units of IM injections (96372) on 1 line and no modifiers unless I have an IV infusion/push code on the same DOS.  

I never bill Medicare carriers the injections on multiple lines, even with the modifier 59 they will deny any additional lines as duplicate and deny.  I haven't had a denial by a Medicare carrier billing this way in over 5 years.

There are a few commercial carriers that want them listed 1 unit per line with modifier 59 on subsequent lines.

This is our personal experience and how we train our new coders.


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## sunitabacchus (May 20, 2014)

OCD_coder said:


> I bill 3 different Medicare MAC carriers at the company I work for, we add the sum total of units of IM injections (96372) on 1 line and no modifiers unless I have an IV infusion/push code on the same DOS.
> 
> I never bill Medicare carriers the injections on multiple lines, even with the modifier 59 they will deny any additional lines as duplicate and deny.  I haven't had a denial by a Medicare carrier billing this way in over 5 years.
> 
> ...




So on 1 line should we be billing 96372 at 3 units with MOD-59? Because even if we put MOD-25 on the office visit, Medicare still denies the first (and all) 96372 if we don't attach a MOD-59 to it.

Because right now we bill this as follows:
1. 99214-25 *paid*
2. 96372-59 *paid*
3. 96372-59 *dupl no pmt*
4. 96372-59 *dupl no pmt*
and only line 1 is getting paid.

Please let me know


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## OCD_coder (May 20, 2014)

992XX - 25
96372  x 3  (no modifier)

I don't know who your Medicare carrier is, I have experience with Novitas, Cahaba, Noridian, NGS and Palmetto billing this format and do not receive denials in my offices.  I have one small commercial carrier that wants them listed on a separate line with modifier 59.  

Note:  I have bill as many as 5 units and gotten paid on all 5.  There is no MUE limit assigned to this CPT code.  But I have heard, not experienced, that Medicare will not pay more than 6 units maximum.


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## sunitabacchus (May 20, 2014)

I actually just finished speaking with a manager at Medicare, and he said that the claim needs to be billed as follows:

Example:
99214-25
96372-59
96372-76
96372-76
Followed by all necessary J codes.

So now I get to spend the next several hours working on this, haha.

Thank you so much for your help, I hope that I'll be able to reach out to you again in the future for assistance


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## OCD_coder (May 20, 2014)

You spoke to an inexperienced Medicare rep that gave you incorrect information and the modifier 76 is incorrect as you are not "repeating" the IM injection as you are giving a different drug for each injection.

These will eventually come under closer scrutiny and potentially be "taken back".  Just be aware.


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## sunitabacchus (May 20, 2014)

You had me concerned after reading you last post. I called Medicare back and spoke with a different manager, and she also confirmed that any additional admin codes after the first one with MOD-59, so have MOD-76 attached to it.

She also provided me with a CMS website for further confirmation.
http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/SE1314.pdf

We're going to give it a try billing with the MOD-76, since it's on the same DOS.


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