Hello!
I am getting feedback from Providence that conflicts with what I understand to be the use of modifier 76 and 59. Here’s how we had bill and WERE PAID ON in the past. 95117(59), 96372, 96372(76), 96372(76). Since Providence did a "clinical edit update" as of 6/1/17, they are now REJECTING this combination and advising I submit: 95117, 96372, 96372(59), 96372(59). This seems to contradict the use of the modifiers and I was looking for professional advise (as I am a CPC-A).
I am getting feedback from Providence that conflicts with what I understand to be the use of modifier 76 and 59. Here’s how we had bill and WERE PAID ON in the past. 95117(59), 96372, 96372(76), 96372(76). Since Providence did a "clinical edit update" as of 6/1/17, they are now REJECTING this combination and advising I submit: 95117, 96372, 96372(59), 96372(59). This seems to contradict the use of the modifiers and I was looking for professional advise (as I am a CPC-A).
CPT Codes 95115 and 95117 – One (1) unit only, when billing for one or more injections given on the same day. … Code 95115 may be used for a single injection; 95117 covers two or more injections. The correct quantity (number of units) is always one (1) for both codes.
CPT® 96372 Therapueutic, prophylactic, or diagnostic injection, specify substance, or drug; subcutaneous or intramuscular
Thank you so much! -Lauren