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Using Modifier 59 for joint and tendon injections

Melissa Posted Tue 29th of November, 2016 12:19:25 PM
I am confused about proper use of modifier 59 when the NCCI edit says a modifier is allowed. For example: The physician performs a right SI joint injection, a right piriformis tendon injection and a right hip bursa injection and a right greater trochanteric injection. My first thought would be that the hip is a single anatomic structure but then I am confused about the words different structure or site. Is the piriformis a separate site or structure? is the hip bursa a separate site or structure? Is the greater trochanteric a separate site or structure? Thank you
SuperCoder Answered Wed 30th of November, 2016 09:21:46 AM

Hi, our team is working on it and will get back to you.

SuperCoder Answered Thu 01st of December, 2016 09:10:43 AM

Modifier 59 is used appropriately for different anatomic sites during the same encounter only when procedures which are not ordinarily performed or encountered on the same day are performed on different organs, or different anatomic regions, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ.  Piriformis, hip bursa and greater trochanteric all are different structure as well as different site.

When injection is performed in muscles,tendon, joint, bursa, they all are different structures and will be billed under different codes. However, if NCCI edit shows bundling amoung any of these codes, then it becomes mandate to append modifier 59 to get payment for all codes. To help you assist better please provide the code list that you have appended for the procedures performed along with some more details of your documentation. Thank you.

Melissa Posted Thu 01st of December, 2016 09:58:46 AM
27096-RT 20610-RT-59 20610-RT-59 20550-RT-59 The documentation is as listed above. Thankyou
Melissa Posted Thu 01st of December, 2016 09:58:47 AM
27096-RT 20610-RT-59 20610-RT-59 20550-RT-59 The documentation is as listed above. Thankyou
SuperCoder Answered Fri 02nd of December, 2016 06:21:30 AM

Yes, this is the correct way of coding for the above procedure performed.

Thankyou

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