Medical Billing Forum
Coding => Coding => : dugmckee February 28, 2019, 04:38:59 PM
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I am a nurse, no coding training, conducting usual and customary charges assessment for an emergency department visit. My question is specifically with radiology billing. Services billed were:
CPT 76380 with Modifier 59, CT C-Spine Limited (the ER notes indicate CT of the Cervical Spine was ordered under CPT 72125, but was billed under 76380 59).
CPT 70450, CT Head/Brain without contrast.
CPT 72100, X-ray Lumbar Spine, 2-3 views.
Can you explain why the Modifier 59 could have been used here for radiology? This was all for MVA patient with neck and back pain, and headache.
Of note, the ER Visit was billed under CPT 99284 with Modifier 25 (not sure what separate issue arose during this encounter).
Thank you for any clarification!
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I am not a certified coder however I believe that because two CT scans were done during the same visit one requires the 59 modifier to indicate it was separate from the other CT scan.
As for the 99284, were there any other codes billed by that provider?
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Thank you, Michelle.
No other codes were billed by that provider. Just the radiology I listed and a couple of oral pain medications. Although, the total billed for 99284 was a very reasonable price, compared to the research I've done at multiple ER's near that area. Probably a moot point.
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So the same provider who billed for the CT scans billed for the 99284? Were they just billing for the reading of the CT scans? If so, the 25 may have been appropriate on the 99284.
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