Q/A: Modifiers for Injections

April 17th, 2018 - Nicole Olsen QCC
Categories:   Billing   Modifiers   CPT® Coding  
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Q: I'm currently receiving a rejection for my billing with BCBS. We've entered 20550 and 20600 as services for the visit. our billing service is saying that they're only allowing 20600 and want to add a modifier to 20550 to get this paid. I'm unaware of what modifier we should use. any suggestions?

A: The most common modifiers for 20550 as per Medicare are listed below. Make sure that whichever modifier you choose is applicable and is supported by the documentation. If none of these are applicable you should check the NCCI edits, or look up the codes on Find-A-Code™ to see more modifiers. If you don't have a Find-A-Code™ account you can create a free trial and view the information, even do a check on the NCCI edits there. When I looked it up it indicated that 20600 would be the only one paid without an applicable modifier, though BCBS could have their own policies regarding the payment and which modifiers are applicable. You may also want to check their policies, and can do so with a free trial at Find-A-Code.

Modifier 58: Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: It may be necessary to indicate that the performance of a procedure or service during the postoperative pe
Modifier 59: Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day.
Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: It may be necessary to indicate that another
Modifier 79: Unrelated Procedure or Service by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period

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