Does CPT code 20610 require a modifier?
Asked by: Mrs. Aracely Nicolas | Last update: March 15, 2025Score: 5/5 (8 votes)
Do you need a modifier for 20610?
If the provider performs injections on separate, non-symmetrical joints (e.g., left shoulder and right knee), you may report two units of 20610 and append modifier 59 Distinct procedural service to the second unit (e.g., 20610, 20610-59) to indicate the second procedure occurred at a different joint.
What CPT codes need a 59 modifier?
Another common use of modifiers 59 or XE is for surgical procedures, non-surgical therapeutic procedures, or diagnostic procedures performed during different patient encounters on the same day that can't be described by 1 of the more specific NCCI PTP-associated modifiers – in other words, 24, 25, 27, 57, 58, 78, 79, ...
Is CPT 20610 bilateral?
Generally, one unit of the 20610 CPT code should be reported for each joint treated. However, multiple units may be reported for multiple joints or bilateral procedures using appropriate modifiers.
How do you know if a CPT code needs a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
- A service or procedure was increased or reduced in comparison to what the code typically requires.
CPT 20610 Documentation Requirements
How do I know if a CPT code needs a laterality modifier?
The -RT and -LT modifiers should be used whenever a procedure is performed on one side. For instance, when reporting CPT code 27560 (closed treatment of patellar dislocation; without anesthesia), modifier -RT or -LT should be appended if only one knee is treated.
Does CPT require a modifier?
According to CPT, the situations when the use of a modifier may be appropriate are: The service or procedure has both professional and technical components. More than one provider performed the service or procedure. More than one location was involved.
Can you bill 99213 and 20610 together?
Per CCI edits, CPT codes 20610-RT and 99213-25 cannot be billed together; however a modifier is allowed with supporting documentation.
What procedure is 20610?
In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a drug into the joint for therapeutic purpose. He performs this procedure without using ultrasound guidance.
Which drugs require a jz modifier?
Effective July 1, 2023, providers and suppliers are required to report the JZ modifier on all claims that bill for drugs from single-dose containers that are separately payable under Medicare Part B when there are no discarded amounts.
When to use 59 or 51 modifier?
Modifier -51 would be attached because the biopsy is the lesser-valued procedure done at the same session, and modifier -59 would be attached to indicate that the biopsy, which is normally bundled with excision of the same lesion, was done on a separate lesion from the one that was excised.
When should a modifier be used?
“Its use allows two E/M services or a procedure plus an E/M service that are distinctly different but required for the patient's condition to be appropriately reported and, therefore, appropriately paid,” the issue brief says. The use of modifiers provides supplementary information for payer policy requirements.
What is the 59 modifier used for?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
What is the modifier for bilateral injections?
Modifier 50 is the coding practice of choice when reporting bilateral procedures.
Is 77002 bundled with 20610?
The code was revised from a stand-alone CPT code to an add-on code. The guideline parenthetical lists primary surgical CPT codes where CPT code 77002 may be reported in addition to the procedure. CPT code 20610 (major joint injection) is included in this list.
Does 20610 require a modifier?
The appropriate site modifier (RT or LT) must be appended to CPT code 20610 or CPT code 20611 to indicate if the service was performed unilaterally and modifier (-50) must be appended to indicate if the service was performed bilaterally.
How to use jz modifier?
The JZ modifier is reported to attest that no amount of drug was discarded. The JW modifier is required to be reported on a claim for the amount of drug that is discarded and eligible for payment.
Do you bill 96372 with 20610?
A patient undergoes a diagnostic injection (96372) for a joint aspiration and also receives an arthrocentesis (20610) during the same visit. Modifier 59 would be added to the 96372 code to indicate that it is separate and distinct from the arthrocentesis procedure.
What is the order of modifiers on claims?
The proper sequencing order for modifiers is as follows: 1) pricing, 2) payment, and 3) location. Location modifier is always reported last in any coding scenario.
What is the difference between modifier 25 and 59?
This helps ensure that healthcare services are reimbursed correctly, especially when different services seem similar but are distinct in nature and necessity. While Modifier 59 explains many separate services in one session, Modifier 25 shows vital, identifiable E&M services on the same day as other procedures.
When to use 59 modifier in physical therapy?
Modifier 59 isn't your billing-free card.
You should apply modifier 59 to denote when you have provided a typically bundled service wholly separate from its counterpart. That's it.
How do you know when to use a modifier?
- A service or procedure has both a professional and technical component, but only one component is applicable.
- A service or procedure was performed by more than one physician or in more than one location.
What is the modifier 25 for injections?
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
Do all CPT codes require a modifier?
Modifiers provide additional information to payers to make sure your provider gets paid correctly for services rendered. If appropriate, more than one modifier may be used with a single procedure code; however, are not applicable for every category of the CPT codes.