Forum - Questions & Answers

Jan 6th, 2010 - kgstell

modifier 59

When my physician performs an occipital nerve block (64405) and an intramuscular injection of a medication (ie toradol) is it appropriate to use a 59 modifier on the 96372 as it is a separate procedure? I find that insurers are denying the 96372 if I do not have the modifier. Seems like it should be reimbursed as it is truly 2 separate procedures.

May 7th, 2010 - billersueb 13 

Re: toradol injections and 64405

It's been 4 months since you posted your question, and I've just begun my journey to seeking the answer to the same question. I'm still researching as to whether or not this would be considered part of the global package for a minor procedure (status = 0 ), because IF allowable 96372 would be appended with modifier 59. That's my understanding. Hope someone more knowledgable can comment.

Sue

May 7th, 2010 - Codapedia Editor 1,399 

toradol injections and 64405

This is what I get when I check the NCCI edits on codecorrect.com

Code 96372 is a component of Column 1 code 64405 but a modifier is allowed in order to differentiate between the services provided.

Does the second service you are performing meet the criteria of modifier 59? Separate and distinct?

May 8th, 2010 - billersueb 13 

modifier 59

Thank you, yes it does ...but was just confused because of the requirements posted by MCR as to what constitutes part of the global surgical package, such as phenergan and morphine being administered before a nerve block and/or chemodenervation procedure. Just wanted to make sure before posting the modifier 59 with the 96372 injections. Commercial carriers appear to differ somewhat in what components are considered in the minor procedure global package.

Sue

May 8th, 2010 - Codapedia Editor 1,399 

Toradol

You might want to check with your specialty society and make sure this is correct before you start billing it.

Is it for pain control/anesthesia during the procedure?

May 8th, 2010 - billersueb 13 

appropriateness of reporting M-59 with injection(s)

Thank you for monitoring this thread. I will check further. BEFORE the blocks were given the patient was administered the morphine and phenergan and AFTER the blocks were given a 65mg injection phenobarbital was administered for the ongoing pain. The need for these injections occur occasionally for our patients, so again was wondering if this would warrant biling the 96372 with the 59, or not.

Sue



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