CMS 1500 - Multiple codes on one date

[DrPerinsCA]

I am a chiropractic assistant for a Dr. that has just started accepting insurance. So far, all our patients with insurance coverage have Aetna. (due to a workplace screening) I am attempting to educate myself on the basics of filling out and submitting a HCFA, and have a few questions. Don't laugh.  (We are using Office Ally's clearinghouse)

1) For example... A new patient receives an exam on their first visit, and also has a 3-v cervical x-ray series taken, I would use codes 99204 and 72050 in 24D. When entering this information on the HCFA, would I enter each code on a separate line with the same date of service? Or can you only bill for one code per day??  

Would the same apply if the same patient comes in for a ROF visit at their next appointment and also receives an adjustment? Can I bill for both 99242 and 98940?

2) Also, from what I understand, I don't use modifiers with Aetna?

3) In box 24J, what is the difference between the NPI, and PIN numbers? NPI is National Providers Identification, I assume? Why would I need to fill it out for every date of service?? And what is the PIN?



Thank you, Thank you, Thank you for your help!


 

[Michele]

First I just want to mention that this is a billing forum, not a coding forum, and some of your questions are definitely coding.  But you are ALWAYS more than welcome to ask, we just may not be able to answer.  I'm not certified in coding, but I do have a lot of experience in coding.  I'm just careful about giving advice when it's not my area.  Anyway, your questions:

1. You can enter many lines for the same date of service, each service or cpt code gets its own line

2.  You shouldn't use modifiers based on the insurance but rather based on if the service requires it.  Some insurances do require modifiers for certain codes such as Medicare does for Chiropractic.

3.  PIN's should no longer be required, only NPI's should be entered in 24J, it is the individual NPI of the provider who rendered the services.  It is required on each line.

Thanks
Michele

[DrPerinsCA]

Sorry about that Michele. I am usually very careful about posting in the right place...thanks for your answer. That explains things for me. I appreciate it. 

[DMK]

For a new patient, use -25 with the exam if you do a 989XX on the same day. This indicates that the exam was a separate service, not just palpation prior to adjusting.  The palpation is assumed to be part of the adjustment.  Other than a new patient exam, you "generally" won't get an exam and adjust on the same day.  Any therapies or modalities should have a -59 to indicate they are a separate service, if in fact they are.

If a patient hasn't presented in awhile, or has a new complicated injury requiring a new evaluation, then use -25 with your 9921X code to indicate a separate service.

[Michele]

It's no problem at all, I just am very careful about giving out coding advice.  You're welcome to ask!  Just can't always answer.



Michele