Author Topic: E/M VISITS AND correct modifier for fine needle biopsy  (Read 3671 times)

mje123

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E/M VISITS AND correct modifier for fine needle biopsy
« on: September 15, 2009, 01:45:49 PM »
Wanted to see if modifier 25 is correct to use for 99309 E/M code and fine needle aspiration biopsy?
 
Used 11100 HCPC code for biopsy.  Medicare denied payment for either code stating it was during "global surgery"

Any suggestions?
 
Thanks

Michele

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Re: E/M VISITS AND correct modifier for fine needle biopsy
« Reply #1 on: September 15, 2009, 10:31:55 PM »
If both procedures were denied for within the global surgical period then it sounds like the patient had a procedure prior to this that is causing the denial.  Right?

Michele
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mje123

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Re: E/M VISITS AND correct modifier for fine needle biopsy
« Reply #2 on: September 16, 2009, 07:33:53 PM »
No, no procedure before this.  Just a regular visit at the ALF with biopsy in room.
 
Is 25 the correct modifier to use with E/M codes for basics like 11100 and 69210?

Michele

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Re: E/M VISITS AND correct modifier for fine needle biopsy
« Reply #3 on: September 17, 2009, 09:50:11 AM »
Yes the 25 modifier is the correct one.

Michele
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MBP

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In office breast biopsy and U/S
« Reply #4 on: October 21, 2009, 01:29:09 PM »
does anyone bill for breast biopsy and u/s guidance? the dr i bill for bought a biopsy device and does her biopsies in the office now. when i bill for it i do 76645 for an initial U/S, then 19103 for biopsy, 76942 for U/S guidance for this biopsy and 99070 for a sterile tray.. the doctor asked me about billing 76098 and 76377 as well as a part of it. any suggestions? she ownes the equipment so i wouldnt use mod 26 but i am still not sure if those cpt apply to it or dont. 76377 would be the u/s after the bx i assume? any suggestions? thank you!

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In office breast biopsy and U/S
« Reply #4 on: October 21, 2009, 01:29:09 PM »

Michele

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Re: E/M VISITS AND correct modifier for fine needle biopsy
« Reply #5 on: October 22, 2009, 11:43:29 PM »
76098 can be reported if the films are interpreted as an integral part of the evaluation. 

76377 is for 3D rendering with interpretation and reporting of computed tomography, magnetic resonance
imaging, ultrasound, or other tomographic modality; requiring image postprocessing on an
independent workstation. (Do not report 76377 in conjunction with 70496, 70498, 70544-
70549, 71275, 71555, 72159, 72191, 72198, 73206, 73225, 73706, 73725, 74175, 74185,
75635, 76376, 78000-78999, 0066T, 0067T, 0144T-0151T)

Hope that helps.

Michele
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MBP

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Re: E/M VISITS AND correct modifier for fine needle biopsy
« Reply #6 on: October 23, 2009, 05:22:13 PM »

Thank you Michele, I gave it to the doctor so she can decide:)

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Re: E/M VISITS AND correct modifier for fine needle biopsy
« Reply #6 on: October 23, 2009, 05:22:13 PM »