Primary Care Coding Alert

Question: What is the correct modifier to use on an injection administration code when a provider gives a patient two injections of two different substances? For example, the provider gave the patient one injection of Kenalog and one injection of Benadryl using 96372 for the administration. In this situation, would I use modifier 51, 59, or 76 to show the payer that these were two different injections?

Missouri Subscriber

Answer: The key to understanding the correct modifier to append to 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) in this particular situation lies in understanding that the provider’s administration of the two different drugs — J3301 (Injection, triamcinolone acetonide, not otherwise specified, 10 mg) and J1200 (Injection, diphenhydramine HCl, up to 50 mg) — constitutes two different and distinct services, even though the injection administration code is the same.

This means modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) would not be the correct modifier to use in this scenario, as the physician did not do the same thing twice when injecting two different medications.

Similarly, modifier 51 (Multiple procedures) suggests that two or more different procedures are being performed at the same session, typically resulting in some economies of scale, which again is not the case. In this scenario, the procedure code is the same while the service is different, and there are no economies of scale resulting from giving the second injection at the same encounter.

The best modifier choice in this case, then, is modifier 59 (Distinct procedural service), making J3301, 96372, J1200, 96372-59 the correct way to bill the encounter.

Coding alert. The note accompanying modifier 59 in CPT^® Appendix A tells you to provide documentation to support your claim that the procedure is different, and to use a modifier 59 only “if no more descriptive modifier is available.”