Wiki Multiple large joint injections and modifier 76

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cindy_b

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I recently received a Cahaba Medicare update stating they are going to deny any claims with 59 modifier unless codes are considered bundled. When we bill out injections of different body sites, for instance - injection right shoulder and injection left hip, we bill it as 20610-RT and 20610-LT-59. Medicare has been denying this and we have to call redeterminations line and get it reprocessed. Now they say we are supposed to use modifier 76 for repeat procedure on same day. This makes no sense to me since it is not a repeat procedure - one is shoulder and one is hip. I know it is the same code, but I
still do not agree with modifier 76. Am I reading this correctly? Any light on this subject would be greatly appreciated.

Cindy Chalk, CPC
Specialty Orthopedics
 
you are correct, a 76 is used for the same procedure repeated in a different session such as a repeat EKG.
For your joint injections you need only the RT and LT do not put the 59 on the second injection.
But if you had LT hip and Lt knee then to list 20610 LT and 20610 LT will bundle together as a duplIcate and you will bill as 20610 LT, 20610 59 LT
 
I'm so glad you agree with me. I called Cahaba and spoke with customer service. She said if the same CPT code is used in the same day, it will deny without the 76 modifier. She instructed me to email them with my concerns since I don't agree with what they are saying at all. Of course they have 45 days to respond. Meanwhile, I'll have claims kicking out left and right. So frustrating!
 
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