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Multiple procedures

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laceyx08:
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:
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.

wymel:
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:
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:
IS this where  A modifier 33 would come into play?

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