Modifier 59 or not for Medicare? (Response)

March 30, 2017

I read with interest your last coding coach on injections…

I read with interest your coding coach related to the following scenario:
The surgeon documented a right shoulder injection with US guidance (CPT code 20611) and a left knee injection without US guidance (20610). Your explanation of when to use the RT/LT and explanation of why modifiers 50, 59 and 76 were incorrect was fantastic. But of course, I have a question about another scenario. What if the surgeon documented the same procedures but the shoulder and knee injections were on the same side? We love receiving the coding coaches and fantastic information that is provided.

Thanks for your kind comments. Your question is a great one! This is an example where modifier 59, distinct procedures falls into place. Again modifier 50 (bilateral procedures) will not work; modifier 76 (repeat procedure) will not work as they are not the same procedure codes; the anatomic modifiers will not work as the two procedures are on the same side of the body. In this case, the most appropriate modifier is modifier 59 to differentiate the injections were performed at different anatomic joints. Let’s assume the injections were to the right shoulder and the right knee. The coding recommendation is as follows:

  • 20611 RT linked to a shoulder diagnosis
  • 20610-59, RT linked to a knee diagnosis

*This response is based on the best information available as of 03/30/17.



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