Wiki ov, 2 injections, modifier question

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dkhclement

dkhclement

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Hi, this came across today and I want to see if the modifiers were applied correctly.
Payer is Medicare/Medicaid.

99213-25
20610-RT
J1020
76881-RT
20610-59RT
J1020
76881-59RT

Rt shoulder and rt knee were injected so could not use mod 50 for bilateral of course. Thanks for any responses. Would you have put the J code one time and changed the quantity to 2? If so, I guess I would need to be the 2 dx for inj 1 and the 2 dx for inj 2 on the J code for the med. Confusing.
 
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I would add modifier 76 to the second 20610 (20610 76/59/rt) and I would bill the drug as J1040 if 40 mg was injected (J1020 is for 20 mg depo medrol-if 40 mg were injected you would code J1030-if 80 mg were injected you would code as J1040). I am not sure why you have added the modifiers to 76881.
 
KMCFADYEN said:
I would add modifier 76 to the second 20610 (20610 76/59/rt) and I would bill the drug as J1040 if 40 mg was injected (J1020 is for 20 mg depo medrol-if 40 mg were injected you would code J1030-if 80 mg were injected you would code as J1040). I am not sure why you have added the modifiers to 76881.
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A second injection given in the same session and different location is not a repeated service and it would be incorrect to append a 76 modifier, the 59 is correct, as far as bill the J code on one line with 2 units or 2 lines with a 59 truly depends on the payer.
 
I'd really like to know if the second 76881 will actually be reimbursed by Medicare. Even if it does fit the criteria as being a service for a separate anatomical area, won't it still be blocked by the MUE's? Do any of you out here who bill for multiple 76881 US actually get paid for for it when billed this way?
 
Just sharing here what I have been taught by the ladies at Zupko and Associates and it has served our practice well.

Radiology procedures require a separate report (a separate paragraph within the procedure note is sufficient) to support billing them separately.

Even though the ultrasound is used on separate anatomical sites, if there is an MUE limit of 1 then only 1 will get paid and should not be billed more than once.
 
Thanks for all the responses. I put it down the way they want me to put it at work. No, that second ultrasound does have difficulty getting paid, but this is the way they want it. Lots of denials. Drowning in them actually. :)
 
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