I have a question regarding the use of the 59 Modifier, and I am not clear on the correct coding.
I have two Scenarios, the first, I am pretty sure I am correct on...the second, not as much.
Scenario #1
Patient has a routine office visit WITH THE PHYSICIAN, and, on the same day, receives a B-12 injection from the nurse, which is not related to the causes the doctor saw this patient on the same day.
MY coding answer would say you bill the following:
99213 with no Modifier for the Physician Visit
AND
96372-59 for the administering of the B-12 by the nurse
AND
J3420-59 for the actual B12 serum.
(or would I also need the 25 Modifier on the 99213?)
This, I am fairly certain, can be done.
Scenario #2 is something I am more unclear about.
It is said one cannot bill 99211 and 96372 on same day, using the 25 Modifier on the 99211.
However, in this case:
Patient comes in, does NOT see the physician, BUT...the nurse gives the B-12 injection AND also checks the patient's vitals.
In this case, can one bill the 99211 and the 96372?
If so, what is the correct coding?
Would you bill this as
99211 (no modifier) with a ICD of V70.0
96372-59
J3420-59
Is that an acceptable coding?
Or can we just simply not charge for the E/M visit in this Scenario, and only bill the normal 96372 and J3420?
Opinions?
I have two Scenarios, the first, I am pretty sure I am correct on...the second, not as much.
Scenario #1
Patient has a routine office visit WITH THE PHYSICIAN, and, on the same day, receives a B-12 injection from the nurse, which is not related to the causes the doctor saw this patient on the same day.
MY coding answer would say you bill the following:
99213 with no Modifier for the Physician Visit
AND
96372-59 for the administering of the B-12 by the nurse
AND
J3420-59 for the actual B12 serum.
(or would I also need the 25 Modifier on the 99213?)
This, I am fairly certain, can be done.
Scenario #2 is something I am more unclear about.
It is said one cannot bill 99211 and 96372 on same day, using the 25 Modifier on the 99211.
However, in this case:
Patient comes in, does NOT see the physician, BUT...the nurse gives the B-12 injection AND also checks the patient's vitals.
In this case, can one bill the 99211 and the 96372?
If so, what is the correct coding?
Would you bill this as
99211 (no modifier) with a ICD of V70.0
96372-59
J3420-59
Is that an acceptable coding?
Or can we just simply not charge for the E/M visit in this Scenario, and only bill the normal 96372 and J3420?
Opinions?
Last edited: