Wiki Denial for inappropriate modifier

[june616]

Please help point me in the right direction to get this injection paid

Claim was originally billed like this:

dx: 682.3

99214-25
10061
96372
J0696

The 96372 and J code denied due to "inappropriate coding" so I added -59 to 96372 and resubmit. It denied again stating that -59 is not the appropriate code to use. I'm what other modifier code be used in this situation? -51?

Thank you!!

 

[OCD_coder]

Since 96372 bundles to the 10061 (primary), modifier 59 would be indicated since it was not used for anesthetic but for antibiotic administration. You have coded it correctly according to CPT rules, your next step would to appeal. If you have an encoder and can show application of the appropriate modifiers with your appeal letter, I have been successful in overturning denials that way.

Try call them and explaining to the carrier your justification. You might win via the phone, might save time.