Author Topic: Multiple procedures  (Read 1317 times)

laceyx08

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Multiple procedures
« on: November 19, 2011, 10:22:05 PM »
I am billing for a family doctor who does a lot of procedures but I'm kind of new at doing this, I'm more knowledgable with mental health billing. If he does procedures without billing an office visit, would there still be a modifier required?

For example, the one I'm wondering about is
23500 (treatment of clavicle fracture)
73000 (Clavicle x-ray)

Any modifiers required for that?

Also, I have one that's kind of complicated for me. Please tell me if I have this one correct:

G0438-25
71020
93000
94010
81002-QW
36415

Thank you so much!!!
Lacey

Michele

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Re: Multiple procedures
« Reply #1 on: November 22, 2011, 02:35:03 PM »
I'm not a certified coder.  If you are not a coder then the claims really should be coming to you already coded.  Based on my experience as a biller I would say your first example would not need a modifier, but the second one is way more involved and I wouldn't want to comment without all info on the visit.  You can't determine if modifiers are needed based on codes.  As a biller you need to be careful and not be adding modifiers to get codes paid.  If there is an audit you could be in some hot water.  You need to make sure that the billing is backed up by the patient chart which is why I can't comment on the second example.

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wymel

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Re: Multiple procedures
« Reply #2 on: November 23, 2011, 04:09:13 PM »
Looking for clarification....We are an outpatient clinic.  Patient comes in for routine wellness (99396).  While here decides he needs to complete a Hep B series (90746) as well we bill out the admin of injection (96372)...oh yeah  may as well remove a skin tag (11200).  Would the 99396 have Mod 25 and the 96372 and 11200 have mod 59 ? ? ?    Different providers have different opinions. 

Nadine

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Re: Multiple procedures
« Reply #3 on: November 28, 2011, 12:29:06 PM »
Lacy-

General rule for mod 25, this modifer may only be billed with an E/M. Your HCPCS code for the PE should be ok with no modifier. Keep in mind, I bill under POS 22.

For the procedure with xray. For x-ray, Consider the place of service (where its done) and who is interpreting. Could either be 26, TC, no modifer. Not much more I can say with limited info.

If this is for a family doc and this is the initial presentation for this tx, I would think an E/M would be warranted, check documentation and ask to query the doc.

ruthie72

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Re: Multiple procedures
« Reply #4 on: November 28, 2011, 07:32:08 PM »
IS this where  A modifier 33 would come into play?

Michele

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Re: Multiple procedures
« Reply #5 on: December 01, 2011, 06:58:18 AM »
I don't believe so.  You need something to indicate that the skin tag removal was separate from the well visit exam. 

Modifier 33: preventive service. Modifier 33 is applied to indicate that the preventive service is one that waives a patient's co-pay, deductible, and co-insurance. An exception is that modifier 33 does not have to be appended to those services that are inherently preventive (for instance, screening mammography).

Most of the services to which the modifier applies are not new, so the list will not surprise you. According to the AMA, CPT modifier 33 is applicable for the identification of preventive services without cost-sharing in these four categories:

    services rated A or B by the U.S. Preventive Services Task Force (USPSTF) as posted annually on the Agency for Healthcare Research and Quality's Web site at http://uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm;
    immunizations for routine use in children, adolescents, and adults as recommended by the Advisory Committee on Immunization Practices of the U.S. Department of Health and Human Services;
    preventive care and screenings for children as recommended by Bright Futures program of the American Academy of Pediatrics and the newborn screening recommendations of the American College of Medical Genetics as supported by the Health Resources and Services Administration (HRSA); and
    preventive care and screenings provided for women (not included in the task force recommendations) in the comprehensive guidelines supported by the HRSA.
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ruthie72

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Re: Multiple procedures
« Reply #6 on: August 16, 2012, 06:50:02 AM »
Thank you