Q/A: Modifiers for Injections

April 17th, 2018 - Nicole Olsen QCC
Categories:   Billing   Modifiers   CPT® Coding  
0 Votes - Sign in to vote or comment.

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

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Healthcare Common Procedure Coding System (HCPCS)
August 13th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
There are three main code sets and Healthcare Common Procedure Coding System (HCPCS), is the third most common code set used. They are often called Level II codes and are used to report non-physician products supplies and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, ...
Q/A: I Billed 2 Units of L3020 and Claim was Denied. Why?
August 13th, 2019 - Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA
Question: We billed 2 units of L3020 but were denied for not using the right modifiers. What should we do? Answer: Rather than submitting two units of the L3020 to indicate that the patient one orthotic for each foot, you would need to use modifiers identifying left foot and right foot. Appropriate coding ...
Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?
August 13th, 2019 - Wyn Staheli, Director of Research
Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.
The OIG Work Plan: What Is It and Why Should I Care?
August 9th, 2019 - Namas
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
CMS Proposes to Reverse E/M Stance to Align with AMA Revisions
August 6th, 2019 - Wyn Staheli, Director of Research
On July 29, 2019, CMS released their proposed rule for the Medicare Physician Fee Schedule for 2020. Last year’s final rule “finalized the assignment of a single payment rate for levels 2 through 4 office/outpatient E/M visits beginning in CY 2021.” It also changed some of the documentation requirements (e.g., ...
Q/A: What if my Patient Refuses to Fill out the Outcome Assessment Questionnaire?
August 6th, 2019 - ChiroCode
Question: What if my Medicare patient refuses to fill out the outcome assessment questionnaire? Answer: Inform the patient that Medicare requires that you demonstrate functional improvement in order for them to determine if the care is medically necessary. In other words, they may have to pay for the care out of pocket if ...
The Slippery Slope For CDI Specialists
August 2nd, 2019 - Namas
Who knew that when Jack & Jill when up the hill to fetch a pail of water, they would have to ensure that in order to keep the level of water the same on the way back down, they would need to both support the pail. Many of you in this industry are ...



About Codapedia by InnoviHealth Systems Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™ by InnoviHealth Systems™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association