I'm working CCI edits for a hospital so this is for technical not professional. Is it appropriate to add modifier 59 to the drug admin code '96374' when on the same claim as the blood transfusion '36430' if the drugs given are to pre-treat for the blood (e.g., diphenhydramine 50mg). These drugs are of course not administered during the blood transfusion. In our system I can see the drug documentation but I'm unable to see the blood transfusion documentation. Is it even necessary to see the blood infusion doc. when we get these particular edits?
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- Posted by Julie Thompson 1 year ago. There are 6 posts. The latest reply is from Patrick Jackson.
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This seems to be a claim only for drug injection as treatment prior to transfusion. Code for drug inj only.
To code for blood transfusion, you need documentation for blood transfusion. Coding both together is rare. -
Assuming the blood transfusion charges are documented then, is it appropriate to append mod 59 to '96374' when the drug is given to pre-treat for the blood but not at the same time as the blood? Pre-treating for the blood is common at our facility.
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Seems you are performing the both between very short time interval. Are you sure that you perform both in same session?
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If by "session" you mean "encounter" (I'm assuming we are talking about the same thing), then yes the pre-treat for blood drug admin is given the same day or same encounter as the blood transfusion but prior to the blood infusion taking place.
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In such a case, it would inappropriate to bill 96374 even with modifier 59 when coding 36430.
Modifier 59 can be allowed if at a different session for another blood transfusion which can't be considered in any way as single encounter. There are many such varying scenarios.
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