Orthopedic Coding Alert

Question: I have been reporting the following code sequence: - 73562-26 - 73562-99 (in the first modifier position, followed by 26, 59, RT, or LT in the miscellaneous text). I have been receiving denials from 10/01/08 onward. What am I missing? Rhode Island Subscriber Answer: You should not have an issue reporting 73562-26 (Radiologic examination, knee; 3 views; Professional services) twice. You may not, however, need to place modifier 99 (Multiple modifiers) onto the second code. You list three modifiers -- 26 59 (Distinct procedural service), RT/LT (Right side; or Left side), which can all fit on the line. Remember: Modifier 99 comes into play when there are not enough spaces (in your system or the carrier-s) to hold all modifiers associated with the procedure. Most systems can accommodate at least two or three modifiers. If a claims requires more than three modifiers, list the actual modifiers in block 19 [...]