Forum - Questions & Answers

Jul 31st, 2012 - tbear

Using modifier 59

Is it ok to use modifier 59 on 96372 when billing 99213 and 20552

Jul 31st, 2012 - agent00711   151 

re: USING MODIFIER 59

I found the below on CPT® Assitant Archives and I think this may help.

Medicine: Therapeutic, Prophylactic, Diagnostic Injections and Infusions, 96372 (Q&A)

Question: What is the appropriate CPT® code to report when a patient receives two or three intramuscular injections?

Answer: CPT® code 96372, Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular, should be reported for each intramuscular (IM) injection performed. Therefore, if two or three injections are performed, it would be appropriate to separately report code 96372 for each injection. Modifier 59, Distinct Procedural Service, would be appended to the second and any subsequent injection codes listed on the claim form. Note that for professional reporting, code 96732 requires direct physician supervision. It is reported per injection, even if more than one substance or drug is in the single injection.

Also, I here are some guidelines to remember when considering using modifier -59

Under certain conditions the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day.

- A different session or patient encounter
- Different procedure or surgery
- Different site or organ system
- Separate incision/excision
- Separate lesion
- Separate injury (or area of injury in extensive injuries) not
ordinarily encountered or performed on the same day by the same physician.



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