Author Topic: coding for consult/office visit and testing  (Read 1683 times)


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coding for consult/office visit and testing
« on: August 18, 2008, 01:00:28 PM »
For new patients, the surgeon will charge for a consultation new patient 99202, (or 99213 old pt) Duplex Ultrasound 93971, and Doppler Study 93965.  Most of the time, the insurance companies will acknowledge and pay for all three.  Once in awhile, an insurance company will deny the consult 99202 or 99213  and pay for the tests.  We use the same diagnosis codes with all of the CPT4s.  Is there a way to bill to avoid the denials?  Thanks for your help, Nancy O.


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Re: coding for consult/office visit and testing
« Reply #1 on: August 18, 2008, 10:17:24 PM »
Hi Nancy,
   You could try using a modifier to prevent the denial of the E&M code.  I would try the 25 modifier on the line with the 99202 (or 99213).  That modifier just indicates:   Significant, Separately Identifiable E&M Service by the Same Physician on the Same Day of the Procedure or Other Service. 

  Another possibility is to use the 59 modifier on the 93971 and the 93965 codes.  The 59 modifier means:  Distinct Procedural Service.

Either of those should work.  If they still deny the E&M code, you can always appeal the processing of the claim.

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