READER QUESTIONS: Think Twice Before Appending 59

Question: If the physician performed a right shoulder injection, a left knee injection, and a left elbow injection, what modifiers should I append to each code? Would it be 59 or 76?


Alabama Subscriber

Answer: Ultimately, if you’re billing Medicare, you don’t need to append any modifiers because none of the appropriate codes are automatic bundles or repeat procedures. So, you’ll just report these codes: 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) twice (once for the knee injection and once for the shoulder injection) and 20605 (…intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]) for the elbow injection.

If you’re sending the claim to Medicare, you shouldn’t use modifier 59 (Distinct procedural service) unless you’re reporting a code that would otherwise bundle into another code you’re reporting. If you’re billing a private insurer, they may ask for 59--check before you drop the claim, because private insurers don’t all follow the same rules.

Modifier 76 wouldn’t be correct either, because that modifier implies that the doctor performed exactly the same procedure twice on the same anatomic site, and these injections were in different places.