Wiki Is a modifier required for a shoulder injection when the ICD10 code is lateral?

[gr8gal61]

I was just informed by an auditor that I was missing the RT modifier attached to the 20610 but I'm not sure if this is right or not. The DX is M75.41 impingement syndrome of right shoulder. If the ICD10 clearly specifies which shoulder, I did not think a modifier was required.

Anyone know the rules for this?

Thanks

 

[mitchellde]

You still use your CPT modifiers. ICD-10 CM did not change anything with CPT.

 

[amymeyers01]

I have been thinking about this too! Most state Medicaid programs don't accept LT/RT modifiers, so I think it will help them rule out duplicate claims, etc. I think this will be addressed in the near future since it would help simplify issues with modifiers. I don't see any real reason for insurance carriers to insist on laterality modifiers when it is documented as part of the dx code. If the insurance companies aren't going to utilize this specificity,then why should we bother to use the lateral digits instead of unspecified for that digit? Just my opinion......

 

[CodingKing]

there was going to be an update to both diagnosis and procedure reporting systems but the government decided it would be too much of a burden on the system and possibly bankrupt smaller practices. You also need to remember the diagnostic and procedure reporting are completely independent of each other. Insurance is just a small piece of the puzzle. The diagnostic data is used for research and statistical purposes independent of cpt data so you would be short changing people outside the insurance realm.

 

[kivbar16]

Payers aren't necessarily looking at the dx codes; they may have systems set up to catch some specific dx codes for specific CPT codes but not all. They also likely don't have a medical necessity license, so won't be looking at every dx. If you were to skip the CPT modifier, you will likely get a denial for missing/invalid modifier. Why would you want to chance getting a denial? First rule of coding: code it complete and accurate the first time.