Coding Corner Question: A Quiz on Modifiers

1. Which modifier is used when there is a separate and/or identifiable reason to bill for both an evaluation and management code and a procedure code?
   1. -25
   2. -24
   3. -51
   4. -59
2. Which modifier is used to indicate that bilateral procedures were done on a patient?
   1. -50
   2. -LT/RT
   3. Both a and b
   4. None of the above
3. A 68–year-old patient with the diagnosis of rheumatoid arthritis of multiple sites without organ or systems involvement, and positive rheumatoid factor, returns to the practice for a second infliximab infusion. The rheumatologist has cleared the patient for the infusion. The patient weighs 145 lbs. Infliximab 200 mg is infused. The infusion begins at 8:25 a.m., and at 9:05 a.m. the patient starts to have an adverse reaction. The infusion nurse starts saline to flush out the medication at 9:10 a.m.; the flush continues until 9:42 a.m. The physician is called and performs a detailed history, a detailed exam and makes a moderate medical decision that the patient can continue the infusion. The infusion is resumed at 10:30 a.m. and completed at 12:05 p.m. Which modifiers should be used to bill this claim?
   1. -25, -59
   2. -25, -XU
   3. Either a or b
   4. None of the above
4. A 66-year-old patient with a diagnosis of osteoarthritis of the right knee visits the office for a second viscosupplementation injection of hyaluronan. The physician sterilizes the area, administers 10 mg of lidocaine and injects the hyaluronan. The rheumatologist sends the patient home with instructions to keep off the knee for a few days and to schedule the third and final injection. Which modifiers should be used to bill this claim?
   1. -RT, -F2
   2. -RT, -EJ
   3. -RT, -E2
   4. -RT,-76
5. A 55-year-old male patient returns to the office with a diagnosis of rheumatoid arthritis of multiple joints with negative rheumatoid factor. He is complaining of knee pain. He rates the pain at 7 on the pain scale, and states he is also experiencing swelling in the knee. He is a cement mason and the pain started four days ago after working all day. He has taken ibuprofen with little relief. He has not had fever, and the knee is not warm to the touch. Review of systems is otherwise negative. The patient’s weight is 255 lbs., his height is 6′ and his temperature is 98.8°F. On exam, his heart is normal with a regular rate and rhythm, and his lungs are clear. His pupils are round and flat. His gait and stance are abnormal due to the swelling in his right knee. His upper extremities and left knee have normal range of motion. The right knee only has a range of motion of 19° and is warm and tender to the touch. The rheumatoid arthritis is stable, but the right knee will need an injection. Magnetic resonance imaging of the right knee is ordered to rule out osteoarthritis. After discussing the possible complications and potential benefits with the patient, he agrees to have the injection. The site is cleansed and then, using aseptic technique, anesthetized with lidocaine. Synovial fluid is aspirated and is normal on analysis. The knee is then injected with 40 mg methylprednisolone sodium succinate. What modifiers should be used to bill this claim?
   1. -25, RT
   2. -25
   3. -RT
   4. -25, -59

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