Author Topic: Help with 67145  (Read 1272 times)

Michelle1965

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Help with 67145
« on: October 22, 2014, 07:47:34 PM »
My provider wants to bill  the 67145 twice during the same encounter for the same eye, because patient has a hole on one part of the eye, and a horseshoe tear on another part of the same eye. Then 3 weeks later she wants to bill another E/M code  and the 67145 again on the same eye, because patient has a new hole. I have been told to use Mod 59 for the first encounter, but I thought it had to be a different anatomical site, and I thought it was only for unbundling 2 separate codes?  Then I was told I could just code the 67145-RT-22 for the first encounter.  I have never used modifier 22 before, and I read the description, and it seems to make sense, then for the 2nd visit I don't feel it should be billed out at all, but I am so confused now! :o Can anyone help me, before I start crying with these 1 or more session codes?  :'(

kristin

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Re: Help with 67145
« Reply #1 on: October 23, 2014, 09:34:57 PM »
You don't say what insurance the patient has, but if it is Medicare, they have made it clear that they consider one eye to be one anatomical site, and billing two lines of 67145 with a 59 modifier is not correct. It is likely that other insurances feel the same way. So a lot depends on how the code description of 67145 reads, and I don't know how it reads. I can rule out other modifiers, such as a 76, based on what you have said, but I can't say whether a 22 would be appropriate or not.

As far as the patient returning during the global period with a new tear in the same eye, see this:

http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Jurisdiction-11-Part-B~8EELJJ7408

Particularly this part: "If a new or different condition appears within the global period, use an appropriate modifier to indicate the treatment is not part of the original series."

I would question the billing of an E/M with the 67145 for the new tear...is the E/M truly warranted?

Michelle1965

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Re: Help with 67145
« Reply #2 on: October 24, 2014, 10:39:01 AM »
I tried to pull up that article, but a message pops up about the license agreement, so I can't read the article.  Is this sometihng I can read on my personal computer at home and hit accept?  I don't want to be doing anything wrong here.  Regarding the second visit you are right, because the E/M code is bundled with the 67145. 

PMRNC

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Re: Help with 67145
« Reply #3 on: October 24, 2014, 11:28:25 AM »
Quote
I tried to pull up that article, but a message pops up about the license agreement, so I can't read the article.  Is this sometihng I can read on my personal computer at home and hit accept?  I don't want to be doing anything wrong here.  Regarding the second visit you are right, because the E/M code is bundled with the 67145.


All Medicare sites have that license agreement, just click agree and you can read the article.
Linda Walker
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