Wiki Modifier

[msjudy71655]

In the clinic where I work, we charge an injection fee. The patient receives an injection for, lets say, celestone and receives injection fee for that shot. Then receives an injection for Clafon and receives a fee.

What modifier applies to the second injection fee?

Judy

 

[SheliaHill]

Injection....

Judy,

I would think "59" for the 2nd injection; however, be sure your diagnosis code selected supports and is linked to each injection given. (i.e., should be different diagnosis)

Based on your health plan contract, the provider may get only one injection reimbursed without appealing said services with supporting documentation.

Good Luck!

 

[OCD_coder]

You do not need a different diagnosis for each injection, only if it applies. You can have a different indication treating different parts of the same condition, one for pain control and one for the inflamation or infection for example.

We bill all of our carriers including Medicare and Medicaid for any injections of the same CPT type on one line with multiple units (e.g. 96372 x2, x3, x4). We have not recieved any denials since we started doing it this way in the past 3 years. It's easier for the coder to remember and appeals are avoided.

It is the preference of each carrier to bill them on separate lines with a modifier 59 on the second line item to denote a different procedure/different anatomical area.

 

[msjudy71655]

Thank you so much. We line item per boss request. I was told modifier 52 but knew that wasn't right. Just wanted to make sure I was on same page.

Thanks again.

Judy