Wiki Modifier 51 or 59? - situation today

Create Wiki
R

rogerandpaula@mchsi.com

Contributor
Messages
18
Location
Archie, MO
Best answers
0
I code for family practice and I have this situation today. Please advise how I should code this. Do I need a modifier due to the new ICD 10 codes providing distinction on the injection for the right and the left? Help!

20610 - M25.561
J7321 - M25.561
20610 - M25.562
J7321 - M25.562

Please advise as I am completely confused and a fairly new coder!

Thank you!
 
You should use the RT and LT modifiers on your procedure codes and combine the total number of units for the J code and bill on one line.
Also if this is for pain management you should read the guidelines on coding for pain management and use the G89 cod first listed if documentation can support one of them.
 
Even though the dx codes specify right and left?

Also I am not familiar with the pain management guidelines, could you please direct me? I am the only coder for this practice and have not had any guidance since I started as a brand new coder.

Thank you for your help!
 
Yes you still use the modifiers on the procedure codes to keep the second one from denying as a duplicate. The coding guidelines should be in the front of your codebook. Or you can go to
http://www.cdc.gov/nchs/icd.htm
And open the ICD-10 CM button look under the 2016 and download the guidelines. These and required under HIPAA to be followed so you really need to be extremely familiar with everything.
 
There was a good article in MLN a couple months ago about some myths about ICD-10. The question you ask is contained

https://www.cms.gov/medicare/coding/icd10/downloads/icd-10mythsandfacts.pdf

MYTH
When ICD-10-CM codes replace ICD-9-CM codes on October 1, 2015, it will impact how I report CPT and Healthcare Common Procedure Coding System (HCPCS) codes.

FACT
When ICD-10-CM codes replace ICD-9-CM codes on October 1, 2015, it will not impact how you report CPT and HCPCS codes, including CPT/HCPCS modifiers for physician services. While ICD-10-CM codes have expanded detail, including specification of laterality for some conditions, you should continue to follow CPT and CMS guidance when you report CPT/HCPCS modifiers for laterality.
 
-59 Modifiers

I currently work for a Chiropractor who does therapy work. 97140 & 97112. A -59 modifier has been used for as long as I have been doing his billing. Recently I have been getting paid a reduced rate on code 97140. The EOB reads: Subsequent/secondary procedure shares duplicate components of primary procedure provided on a single date of service. 1/2 the practice expense portion of this service has been reduced. Any idea what I can do to get paid for the full amount?
 
You must log in or register to reply here.
Top